Client First Time Evaluation Forms

Prior to your very first consultation, could you please fill-in the information requested contained within the form category suitable to yourself, or a child, and send it to me.  Please select the relevant form option below.

Female Form
Male Form
Child Form (12 Years old and under)

HIPAA-Compliant Online Forms

The HIPAA-compliant form used on this website automatically encrypts the information you enter and will save this into the secure database when you press the Submit Button, guaranteeing the privacy of your information. Your data is protected by a 256 bit SSL (Secure Socket Layer) connection that uses a SHA256 Certificate. It is the industry standard protection. This secure service is used by medical and other organisation requiring absolute security of their patient/client private information.

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