A PDF of your completed form will be sent to the email address you provide below.

Please upload a fully dressed picture of yourself (within the last 24-hours) from the waist up with no one else in the picture, including pets, for Gary to scan while reviewing your intake form. The image must be in either a JPG, PNG or PDF file format and the file size must be smaller than 8 MB. There will be a place to submit this file at the end of the form. It might be easiest to have this picture file prepared before beginning to fill out the Session Follow-Up Form.

Session Follow-Up Form

Please complete and submit this form 24 hours in advance of your next session. All boxes need to be filled out in order to submit the form. (ALL INFORMATION IS STRICTLY CONFIDENTIAL)

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Today's Date*


Accepted file types: jpg, png, pdf, Max. file size: 8 MB.
This field is for validation purposes and should be left unchanged.