FORMS to complete prior to first session

Adult Intake Form

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

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

Credit Card Payment Consent Form (Complete if you wish to use a credit card)

Angela's disclosure statement

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.