Client Forms
Below are forms you can either download and fill out or submit online.
New Client Forms
- Client Questionnaire
- Notice of Privacy and Confidentiality Practices
- Authorization for Release of Confidential Information
Please submit your information for your first appointment.
Authorization for Release of Confidential Information

"There's no way to grow without taking a few risks."
Body + Soul Magazine

"At any given moment you have the power to say: This is not how the story is going to end."
Unknown

"The person who removes a mountain begins by carrying small stones."
Chinese proverb

"To love oneself is the beginning of a lifelong romance."
Oscar Wilde

"All Life is an experiment. The more experiments you make the better."
Ralph Waldo Emerson

"Not until we are lost do we begin to understand ourselves."
Henry David Thoreau

Beth Mayer, LICSW, Executive Director, MEDA

Current client

Daniel Beck, LICSW and Founding Fellow and Diplomate of The Academy of Cognitive Therapy

Current Client