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New Client Forms

Welcome to LifeSwitch

Thank you for trusting me in guiding you to forge a new path, a new perspective, and a new existence. What lies ahead is a purposeful, fearless and regret-free life that clears the hurdles that serve to prevent most of us from even understanding our true potential, much less reach it. It is true that the goals of our work together include living without drugs and alcohol; but it’s so much bigger than that! Freeing oneself from the ball and chain of alcohol and drugs is a necessary and impactful beginning that no doubt offers many positive results all by itself. But our short journey together can also be the catalyst towards a new life that is so rich and rewarding it defies even your greatest imagination. In the words of Dr. Seuss, "Oh the places you will go!"

So take a deep breath, clear your mind of preconceptions that have thwarted progress before, and get ready for a journey that promises to change your life.



  1. Please read all of the documentation in the New Client Packet
  2. Fill out the New Client Intake Form starting on page 3, then sign and date it on page 5.
  3. Please answer the questions in the Personal Overview on pages 6 - 8. If you aren't comfortable due to the personal nature of some of the questions, that's fine we can go through them together in your first session.
  4. Carefully read the “Counseling Agreement and the Informed Consent” which begins on page 9 and then electronically sign the acknowledgement on page 13
  5. Carefully read your HIPAA rights on page 14 and 15 and then electronically sign and date page 16.
  6. If there are files, evaluations or other information you want us to have from your former counselor, doctor or rehab/detox facility, please fill out and electronically sign the INBOUND release on page 17
  7. If there is someone, many times a family member, whom you trust to allow me to speak with them in the future about your treatment when helpful, or if you disappear or there is an accident in our office, please fill out and electronically sign the OUTBOUND release form with the contact information for that trusted individual on page 18.

Once you have completed all forms and electronically signed all the required documents, please download with changes made and confidentially send the packet to the email address below:

If you want something you've never had, you have to do something you've never done.
Thomas Jefferson
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The consultation is always free. Let's make sure LifeSwitch is the right solution before moving forward.

Our goal is to reply same day within a few hours of your request. However we ask that you allow 24 hours before submitting again or calling. We do not work on Sundays except in emergency. Thank you!

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