When words are not enough

FORMS to complete prior to first session

Angela's Disclosure Statement for Clients

Angela's Disclosure Statement for Clients (in Spanish)

Adult Intake Form

Check List for Children Under 5 yrs. of Age

Check List for Children Under 5yrs (Spanish)

Child/Teen Intake Form (to be completed by parent)

Child/Teen Intake Form (to be completed by the child/teen)


(complete if you wish to use a credit card)

Credit Card Payment Consent Form

Credit Card Payment Form (Spanish)

Information FORMS for personal use

How do I Prepare my child for therapy/ what is expected of me?

How to talk to a child about a parent's addiction

Why choose dance or drama therapy?

Angela's LPCS disclosure statement (for LPC's receiving supervision)


Make a Credit Card Payment

I use the secure payment processing services of ProfessionalCharges.com to handle online Debit and Credit Card payments.

To Make an Online Payment: Click on

https://www.professionalcharges.com/account/clcharge.php3  

   and the payment form will open in a new window. Enter your name as it appears on your card. Insert my License Number LPC6642 in the space for the Provider's License Number. Complete the form and click on the Submit Payment button at the bottom. Print yourself a copy of the receipt that will appear on screen.