The registration form is used to gather basic contact information from you so I know how reach you if needed outside of the therapy session. Additionally, for those using insurance, this information is needed so that insurance claims can be submitted properly. Please make sure to fill out the second page requesting information that can be directly taken from your insurance card. The third page asks for your signature and date. Your signature indicates that you agree to the terms of payment that has been addressed whether or not insurance is applied. When submitting claims, it allows my practice to submit claims to the respective insurance company. So please make sure to download, print and complete this form to bring along with you to your first appointment. I will also need to make sure that I receive a copy of you insurance card at the time of the first session.

Download Client Registration Form