Therapy Forms
If you’re a new therapy client, please print and complete the Therapy Intake Packetbelow and bring it to your first therapy session. If you would like Dr. Orma to coordinate care with another provider (e.g., psychiatrist, primary care physician, etc.), also complete the Release of Information Form below to authorize release of psychotherapy information, and bring it to your first session as well.

Payment can be made by credit card. Please contact Dr. Orma for information regarding fees.

To make a payment with your credit card, just click on the “Pay Now” button below. You’ll be taken to PayPal’s Website where you can fill in the payment amount and complete the transaction safely and securely.

Therapy Intake Packet
ED Questionnaire
Release of Information
Note: To download Adobe Acrobat Reader for free, click here.

Life Quality Improvement Center


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