Contact

Prior to making an initial appointment, please fill out and send via email:

• Intake Form (a credit card on file is required) 

• Therapy Agreement Form 

• Permission for Trainings (send via email-delete). 

• 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.