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African American Couple

Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form
Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  

Note: To download Adobe Acrobat Reader for free, click here.



Offering Therapy and Counseling services for a variety of issues, but specializing in Marriage Counseling and Hypnosis for self improvement

Serving all of Broward and South Palm Beach Counties, including:
Plantation, Davie, Weston, and
Fort Lauderdale - FL - Florida