Policies & Forms

Insurance Policy

I accept Husky insurance through the State of Connecticut. Many other insurances will cover therapy as part of your out of network benefits. I will provide you with a statement to submit to your insurance company at your request. Insurance cannot be billed for co-parent counseling, divorce mediation, or collaborative divorce coaching.

Cancellation Policy

When we schedule an appointment, I reserve that time specifically for you and ask that you keep the time reserved for you. In the event that you do need to cancel, please be certain to contact me at least 24 hours in advance to avoid being charged for the appointment.

(Husky clients are excluded from this policy as mandated by the State of Connecticut.)

REGISTRATION FORM

Registration

Form

Please read the Registration document attached.

The privacy of your treatment is extremely important to me. Please read the HIPAA document attached.

HIPAA FORM

HIPAA

Form

Please take the time to thoroughly read and sign the informed consent. You may print it and bring it with you to our first appointment. If you would like to communicate electronically, please read and sign the Consent for Electronic Communication.

If you have Husky insurance benefits through the State of Connecticut, please sign that specific consent form.

Policies & Forms

Insurance Policy

Cancellation Policy

REGISTRATION FORM

Registration

Form

HIPAA FORM

HIPAA

Form

Consent Forms

INFORMED CONSENT FORM

INFORMED CONSENT FORM

(HUSKY INSURANCE)

ELECTRONIC COMMUNICATION CONSENT