Fees & New Client Info

Do you have any experience in mind-body medicine (i.e. meditation, imagery, biofeedback, nutrition counseling, yoga, spirituality classes)?

List the members of your family and all others in your home including Name, Age, Relationship, and Occupation

Education

Occupation

Cell Phone

Address *

Email: *

When were you last examined by a physician

Who referred you

Date of Birth

Age

Home Phone

Name of Physician

Name: *

Please state your preference for appointment days and times. NB: I do not offer late evening or weekend office hours unless it is an emergency.

Have you ever received psychiatric or psychological help or counseling? If so, explain

Marital Status

Is there anything else you would like for me to know about you and any insight you would like to share as to why you might be experiencing difficulties?

Briefly describe your reason for seeking help

List any medications you currently take

New Client Information Form

Debra Lewis Kaplan, LCSW, LMFT

List any health problems for which you currently receive treatment

Hello,

I am an integrative psychotherapist, and I focus on the physical, emotional, and spiritual levels of health and development of my clients. I help many people go to a deeper place of understanding about their issues and use spiritual guidance and intuition to do this.

I usually schedule a one hour phone or office session and sometimes people ask for just one or schedule ongoing sessions. My fee is $200 an hour and is reimbursable by many insurance companies that offer mental health benefits. I accept all major credit cards or checks.

There is an an intake form included on this page that I will need you to fill out as completely as possible before our first session. Let me know if you have any questions. I look forward to guiding you.

Thank you and be well,

Debra L. Kaplan, LCSW, LMFT