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Referral Form

Please complete Referral Form and include your name and contact information.  Completed forms can be faxed to (888) 700-6760 or emailed to us at  We will follow up with you and potential client within 48 hours.  

Please feel free to call our office in Sarasota at (941) 888-2081 to confirm our receipt of the faxed Referral Form.  
Click here to download Referral Form

New Client Demographic Forms 

Completed New Client Demographic forms can be faxed to (888) 700-6760 or emailed to us at Please call us at 941-888-2081 for assistance completing these forms.  Please note:  These forms can also be completed by creating an account on our on client portal. 

Download New Client Demographic Forms 

Filling Out a Form
Modern Senior Woman

Online Forms Submission

You can register and complete all new patient forms online! 

Just click on the portal link below to create an account and submit your information via our secure Client Portal.  Once your portal is created we will contact you to confirm your insurance and schedule your first session.  

Click Here to Create your Client Portal

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