New Clients

Important Note: We are accepting new clients. No insurance, private pay only.  please email becky@doctorbecky.com.

Get in Touch

Becky would like to hear from you,* simply complete this form and submit. Please allow 48 hrs for a response. * Please no marketing calls.

• Name*
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• Email*
• Phone
• Your Note:*

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For your convenience, we have provided digital intake forms here for new clients.

After making your first appointment fill out the forms online and they will be sent to us automatically.

Locate both the client intake form and the Informed Consent/policies form, below. It is one link for both forms.  They must be received prior to your appointment, or your appointment will have to be rescheduled.

1. Download the forms (Intake Form + Informed Consent) fill out, and they will be sent to us automatically.
2.  It is ESSENTIAL that you read, fill out where necessary, and sign the INFORMED CONSENT, as counseling cannot begin without your signature on this form!!

All Digital Forms – Fill it Out and it’s Sent to Us Automatically …

History Form and Informed Consent

Cancellation policy:
– If you cancel 48 hours or more before your scheduled session: 90% refund.
– If you cancel 48-24 hours before your scheduled session: 50% refund.
– If you cancel less than 24 hours before your scheduled session: No refund.