Welcome and let's get started
1. Consent Forms
These should take 10-15 minutes to complete. If you prefer to not complete the forms electronically, you can download the documents directly below.
Please print, sign and send via email to email@example.com or fax to 702-331-5400.
Scroll here to complete the forms electronically:
We use Chiron Heath for video sessions and if you requested online appointments, you will receive a separate email from them with the appointment information. They are HIPAA compliant and work specifically with medical professionals. Chiron Health will ask you to create a login/password and submit a credit card to keep on file. You will only be charged after we have had a session. If there are any late cancelations or missed sessions, you will receive an invoice for payment.
Prepping for Online Sessions
1. Use wi-fi when possible as cellular data is less stable.
2. If there are any problems with the quality of video/sound, we will use the phone so you can call me at 702.706.4786.
3. Use a headset/earbuds for extra privacy.
4. Find a truly private space to feel more at ease with sharing.
5. Most people feel most comfortable when they're sitting and the computer/phone can be stabilized on a table, desk, phone holder, etc.
These are all the forms contained in the electronic version above.
Click on images to download. Send via email/fax/mail.
They must arrive prior to our first appointment.
Notice of Privacy Policies -REQUIRED
This form is a summary of your rights to privacy and access to your records. This is according to state and federal laws.
Therapy Agreement - REQUIRED
Informed consent means that you have a right to know about the services you are about to take before you make a decision to engage in the treatment. In fact, you don't really become a "patient" until this is signed and we have our first session outlining what kinds of concerns you have, possible diagnosis, and agreement on treatment. This outlines many questions that patients have about therapy but it is not exhaustive. Please always ask questions at the start of services or anytime during treatment.
Registration and Signature Form - REQUIRED
This is all of your pertinent information, including your residency address, which must be in Texas or Nevada. An ID number may be asked as a proof of residency. Signing this document means you also ready the above 2 documents as well.
Fee Agreement - REQUIRED
This outlines the fees and methods of payments for services.
Consent to Release Information - optional
Please download and fill out this form if you are receiving care from another provider.
- medical providers
- couples, group, individual or family therapist
This form is not required to begin or continue treatment but it is helpful if you have it already filled out before we start. We will discuss as it's applicable to your care.