Please complete the following forms as necessary :

  • Therapist/Client Contract (2 pages)
  • Client Information
  • Primary Insurance Information
  • Email Authorization
  • Credit Card Authorization Form
  • HIPPA Form

  • Please print out each form you require and fill out completely prior to our first session.  If you have any questions reguarding the forms, please feel free to contact me either through phone or email.

    After printing a form, use your browser BACK button to return to this page.


    Melissa accepts a variety of private insurance. She also accepts Visa, Master Card, and Discover