Client Forms

If you’re a new client, please complete the following registration forms and which Intake form that applies to you.┬áPlease bring them to your first therapy session.

Adult Intake Form

Child Intake Form (Parents fill out for all ages)

Adolescent Intake Form (12- 17 year old fill out)

Client registration form

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization of Release of Information


Contact Today

13895 Hedgewood Drive #229
Woodbridge, VA 22193
(571) 659-9961

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