Intake Form

By downloading, printing and completing this form prior to our first visit, you will save more time for talking rather than paperwork. If you are unable to complete this in advance for any reason, please arrive 5-10 minutes before your scheduled appointment time to fill this out in the waiting room. Thank you.

Informed Consent

“Informed Consent” refers to a body of policy disclosures that all licensed mental health professionals are required to provide to the clients they treat. It covers many of the subject areas found elsewhere on my website, and much more. Please take the time to look this document over and feel free to ask for any further explanation in order to ensure that you clear and confident about your treatment experience.

Informed consent is for both your protection and the provider’s. Clients need to understand their rights, risks, and responsibilities when entering a therapeutic process, and the Informed Consent disclosure is what makes all of these elements transparent.

In Case of Emergency

Solo practitioners like myself typically do not have the same resources available to respond to emergency situations on a 24/7 basis that larger practices may provide. When clients have reason to anticipate needing immediate crisis intervention support, they are advised to consider seeking treatment at a community mental health center or other agency that offers a more extended range of services for responding to emergencies.

It is my practice to monitor my phone and email messages regularly and respond to emergencies whenever possible. However this is not a service that I can guarantee on a 24/7 basis. If you have an emergency, I will respond to your contact as soon as I am able to, however in the meantime there are instructions on my answering machine and this website for how to access emergency support elsewhere (see below).

Dial 911 to report your emergency if it is life threatening.

Proceed to your local hospital emergency room.

Call the crisis hotline number of your community mental health center (Strafford, NH: (603) 742-0630, Rockingham, NH: (603) 431-6703).

Call your psychiatrist if you have a medication emergency.