Contact

In making an initial appointment, please fill out the Intake Form (a credit card on file is required), the Therapy Agreement Form, and the Permission for Trainings (send via email). An Authorization for Disclosure is only important if you would like me to connect with other disciplines in your care. Once I receive these forms you can make an appointment by contacting me via phone, email, or text (text is recommended for quicker response). 

I provide a free 10-15 minute initial consultation via phone or email to find a mutual available time!

annetteak@yahoo.com
(954) 471-4495

Forms

Intake Form*

Therapy Agreement Form*

Permission for Trainings*

Authorization For Disclosure

Insurance Inquiry

*Please note I do not accept insurance, I am not on any insurance panels, and I do not bill insurance companies. Therefore, you will need to pay for services. I can, however, try to assist you in reimbursement by your insurance company by providing you with a receipt for you to apply for out-of-network providers coverage.