Patient Forms

We offer a discounted sliding fee schedule that is based on family size and income. We offer services to all patients regardless of ability to pay. Please complete this application and provide supporting documentation to be reviewed for participation in this program.

If you are new to working with us, please be sure to fill out each of the following forms, and bring them to your first session.

Medicaid clients, please fill out this form and bring it to your first appointment.

If you feel that you would like to collaborate your treatment with another provider, please fill out the following form.