Individual Counseling, Couples Counseling and Sex Therapy

Intake Paperwork

For our mutual convenience, prior to your appointment you can download, fill out and sign the following documents rather than completing them in my office.  If you are a couple, please download and fill out 2 sets of paperwork, one for each of you.  If you have any questions, you can either email me at (if you prefer a more secure means of communication, please sign up for a hush mail account and email me through their software), call me at (813) 404-9215, or just ask me on the day of your appointment.

Required For All Clients:

Required if using insurance:

For Your Reference:

Required for Sex Therapy:


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