REBUILD YOUR LIFE ON A SOLID FOUNDATION

Current Client Forms…

Revoking an Authorization
There may be a situation where you would like to terminate a Release of Information which you signed earlier in your treatment. Please use this form to revoke the release. I must receive this form completed and signed by you. It will then be placed in your clinical record and no further information or contact by me will be made to that entity.

Payment Agreement

George

"Life isn't about finding yourself. Life is about creating yourself."

- George Bernard Shaw

Harvey

"Never be bullied into silence. Never allow yourself to be made a victim. Accept no one's definition of your life; define yourself."

- Harvey Fierstein

Rumi

"Your task is not to seek love, but to seek and find all the barriers within yourself that you have built against it."

- Rumi

Anna

"I was always looking outside myself for strength and confidence but it comes from within. It is there all the time."

- Anna Freud

Vivian

"Life is not about waiting for the storms to pass. It's about learning how to dance in the rain."

- Vivian Greene

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