Registration
ONLINE REGISTRATION FORM Your Name: Date of Birth: E-mail Address: Home Address: Home Phone: Employer: Occupation: Work Address: Work Phone: Driver’s License Number: Emergency Contact Name: Emergency Contact Phone: Referred By: Physician: Medical Conditions: Current Medications: FEE AGREEMENT: Professional fees are based on $125 for a standard 50 minute session. Psychological assessments, consultations, and reports are [...]
