Helpful Forms

The following forms are provided for your convenience. Please click on a form to download the PDF.
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• Patient Registration Form
• Release of Medical Information Form
• HIPAA Form
• Privacy Practices Awareness Form
• Schedule of Fees
• Credit Card on File Authorization Form

Have a Question?

Contact the office manager, Rikki, by calling 434-244-3771 or send an email.

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Areas of Practice

• Anxiety Issues
• Mood Issues
• Difficult Relationship Issues
• Significant Life Transitions
• Life Direction, Values, and Meaning