Please note that my practice is presently quite full. So, it is likely that, for now, you might be put on a waiting list. The next 2 slots that open will be reserved for college students and/or young adults ages 18-27
The minimum age to be accepted into my practice is 17. I do ask that this form be completed by the person seeking treatment her/him/itself.
Please select the anxiety disorder(s) below that you are seeking treatment for
In the space below please provide a description of the specific symptoms of the anxiety disorder(s) checked above, as listed on the page(s) describing that condition. Please be as specific as possible, focusing on your present symptoms, and the impact of these on your life now. Also please describe WHY you are MOTIVATED to change and the reason(s) you are seeking treatment now. You can also include other issues or challenges affecting you.
I have read the page on your treatment approach
Please indicate below if you are covered by one of these plans