If you are a new client, please complete this form and bring it with you to your first appointment. If you forget, no worries — we have copies at the office. This just saves a little time.
Authorization for Release of Information
If you would like to authorize us to coordinate care with another provider (such as a primary care doctor, or a psychiatrist), please complete this form and bring it with you:
Have questions, comments, or want to schedule an appointment?
Information submitted via this form is encrypted for privacy. If after clicking “Send” you are not taken to a “Thank you” page, your email did not go through. Please call us directly at (414) 377-0504.
Please do not use this form for emergencies or crisis situations. If you are having an emergency, please dial 911 or go to your nearest emergency room.