NOTE: New clients must complete the Intake Paperwork, which can be accessed through the secure Client Portal.
Credit Card Authorization for Same-Day Cancellations and No-Shows
- All clients are required to keep a credit card on file for charges related to same-day cancellations and no-shows.
- Use this form if you were not able to download/print the Credit Card Authorization from your Client Portal.
- Use this form if you need to update your credit card information.
Credit Card Authorization for All Appointments
- Use this form if someone else will pay for your sessions but will not be present each time you attend.
- Use this form if you would like to pay for someone else's sessions in your absence.
Authorization for Release of Information
- Use this form if you would like to permit Shameela to consult with someone else about your treatment.
- Examples include, but are not limited to: other family members, other counselors/therapists, psychiatrists, doctors, etc.