Forms

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

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

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

CONTACT US

We hope to see you soon

  • Igniting Change

    481 E 1000 S,
    Suite A,
    Pleasant Grove, UT 84062

    Monday:

    9:00 am - 6:00 pm

    Tuesday:

    9:00 am - 6:00 pm

    Wednesday:

    9:00 am - 6:00 pm

    Thursday:

    9:00 am - 6:00 pm

    Friday:

    9:00 am - 6:00 pm

    Saturday:

    Closed

    Sunday:

    Closed

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Please do not submit any Protected Health Information (PHI).