Please print appropriate forms below, scan (or take a picture of each page), and email to [email protected] prior to our first appointment-thank you!

Complete one of these forms below that apply:

Complete this form below only if you wish me to consult with one of you current providers.

Note: To download Adobe Acrobat Reader for free, Click here.

member of

Arizona Autism

Please feel free to reach out to me at 928-710-8497


Office Hours

Please do not hesitate to request evening or weekend hours


Monday - Friday:

9:00 am - 5:00 pm

Saturday, Sunday:


Please feel free to contact me!