Please select the appropriate tab below.

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Please submit your completed intake form before your appointment date (click on the green button below). By making an appointment, you agree to the Cancellation/Payment Responsibility Policy.

Intake Form

Before sending and receiving health information via email please read and sign the form below. Email_Consent_Form. I often send follow up notes via email for your convenience.

Download and read the HIPAA form to learn your rights regarding your health information. HIPAA_Form

By making an appointment, you agree to the following cancellation policy:

  • A cancellation fee equal to the full price of the scheduled appointment will be charged for No Show appointments and appointments that are canceled or rescheduled with less than a 24-hour notice.
  • A cancellation fee of 50% will be charged for cancellations/reschedules made between 24 and 48 hours of your appointment.
  • Any No Show/Cancellation fee incurred will be billed to your credit card on file. If your credit card is declined the payment must be received by our office with in 30 days of the missed appointment date. After 30 days of non-payment, interest accrues at 12% per month. After 120 days of non-payment, the account will be sent to a collections agency.

 

 

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