Overcome Anxiety Clinic Forms

Please download, fill out, and return intake forms before our first session

Intake Forms

Health & Medical History + Liability Waiver




How to fill out your forms electronically

If you don't have it already, download Adobe Reader. It's free to download and use. Use the "Fill & Sign" feature to fill out the form, save it, and email it back to me. It's important that I receive your intake forms before our first session so that I can prepare accommodations for any unique needs you may have.

email your forms to: fivebodywellness@gmail.com


Unable to complete your forms electronically?

If you have a printer, you can print your intake forms, fill them out by hand, take a photo (it must be legible) of your forms and send me the pictures.

Or, instead of taking pictures, there is an app called Camscanner that I used as a behavioral therapist to submit confidential paperwork to the office. It uses your camera to take a picture of your paper and converts it into a pdf to send securely (and legibly). You can even save multiple pages to one file.

If you need a paper copy of your forms, I can either mail them to you with a self-addressed and stamped return envelope, or you can pick them up/drop them off at our host center. With this option, please be advised that mail service is delayed and you will not be able to join our live sessions or the online portal until I receive your intake forms.


How do you protect confidential information I share with you?

All of the files I receive are held in a password protected external drive and are permanently deleted from all other platforms. I take every precaution to comply with HIPPA regulations, holding any and all information shared with me in confidence.



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