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Helpful Forms

If you’re a new client (or need to update your records) please complete the following forms and bring them to your first appointment.

Consent to Treatment – for Michelle’s clients and group members

Consent to Treatment  – for Mark‘s clients and group members

Patient Information

For your information: Summary of HIPAA Privacy Rule

If you would like one of us to coordinate care with another provider (e.g., psychiatrist, primary care physician, school counselor, etc.), complete this form to authorize obtaining and releasing of information:

Authorization for obtain or releasing confidential information 

Professional Disclosure Statement and Agreement for Clinical Supervision

 

Groups - Currently Enrolling

A Dream Group for Clinicians – Now Enrolling

Fourth Sunday of the Month, 6:30- 8:30 p.m. for four weeks

Explore the dream material and learn about its structure, symbolism, and relevance to the current context of the dreamer.

Details & Registration >

Professional Supervision Group

First and Third Sunday of the Month, 6 - 9 PM, On going - Lansdowne Location

Use your own art, active imagination, personal imagery of dreams and fantasy, as well as creative writings, to deepen your understanding of your clinical work and professional relationships. This unique bi-monthly supervision group is for mental health professionals who are seeking to enrich their work through the use of depth psychology practices, including art making, active […]

Details & Registration >

Art Therapy Support Group for Men and Women Struggling with Eating Issues

Fridays, 7 - 8:30 PM - Lansdowne Location

Support group for men and women struggling with eating disorders and food issues in Philadelphia area

Details & Registration >