Disclosure form


It is always good to set up some rules in advance. This will easier process for the both of us and will let us focus more on the work ahead.


Everything we discuss in session is held in strictest confidence. According to law, with certain mandated exceptions, I may not reveal anything you say—not even, for example, to your family.

I may, of course, share confidential material if I have your written permission. I may request this permission, for example, to communicate with your previous or current health care practitioners. Carefully collecting information in this way, particularly during our first few weeks together, can make the therapy process more efficient, saving you time and money.

I am permitted by law to break confidentiality when 1) you are in such mental or emotional condition as to be imminently dangerous to yourself or to the person or property of others, and 2) my disclosure is necessary to prevent the threatened danger.

I am required by law to break confidentiality:

* If you reveal you are currently abusing a child or dependent adult;

* In so‑called Tarasoff situations‑‑when you communicate a serious threat of physical violence against an identifiable victim;
* If you reveal you have looked at or currently look at legally forbidden depictions of childhood sexuality;

* If a valid subpoena is issued.


Sessions are scheduled for 50 minutes. If our session begins late because I am behind schedule, we will meet for your full scheduled time. If we begin late because you are late, we will meet for the remainder of your scheduled 50 minutes. When I am seeing a couple, we will only begin when both mates are present.


Feel free to choose a single therapy or will book a package.


All appointments not cancelled 48 (not 24) hours or more in advance will be charged at the full rate.


You have the right to terminate therapy at any time.

In my experience, therapy typically terminates by mutual decision. You accomplish your goals—
the ones you came in with, ones you developed in therapy, or both—and we agree to end therapy.