Forms and Policies

New Patients

Before meeting for the first session, please download, print and fill out these forms and bring them to your appointment. Alternatively, you may arrive 20-30 minutes prior to your appointment time to fill them out at the office. They will be available in the waiting room. Feel free to call me if you have any questions.

Intake Form

Registration, Practice Policies, Informed Consent to Treatment & Payment Policy

HIPAA Privacy Policy

Telehealth Consent

Authorization for Release of Information

Confidentiality & Privacy Policy

Confidential communication is key to a strong therapeutic relationship. The law protects the privacy of all communications between a patient and a psychiatrist. I cannot disclose information about you without written permission.

Exceptions include:

  • You report intentions to harm yourself or someone else
  • Suspected child abuse or dependent adult or elder abuse

24-Hour Cancellation Policy

Regular attendance at appointments is important. If you need to cancel an appointment, please call to inform me of your need to cancel as soon as possible. I may be able to reschedule your appointment.

If you do not show up for your scheduled appointment, and you have not notified me at least 24 hours in advance, you will be responsible for the full cost of the session you reserved. This fee is not reimbursed by insurance companies.

Emergencies and Crisis Situations

I will make every effort to respond to messages and phone calls in a timely manner. However, I am unable to provide urgent, crisis, or emergency services over the phone. If you are experiencing a life-threatening crisis and require immediate assistance, please call 911, or go to the nearest emergency room.

If you are feeling overwhelmed but are not in an emergent crisis, you may call the Georgia Crisis and Access Line (GCAL) at 1-800-715-4225.

For non-urgent matters or for scheduling issues, please email or leave a message on my voicemail. Note that email is not a secure, confidential form of communication. It should not be used to discuss clinical issues or for urgent communications

Patient Portal

Coming soon.