Registration

SUSAN GROSS, LCSW 

203-300-3101

Susan@SusanGrossTherapist.com 

Denver, CO  80218 

 

NEW CLIENT REGISTRATION FORM 
Can messages be left?
Can messages be left?

By electronically submitting this form to  Susan@SusanGrossTherapist.com  via email  you are agreeing to engage in a coaching relationship with Susan Gross, LCSW for the sole purpose of addressing a life situation that is limiting your emotional well being. 

 

Services are not provided for legal, employment or disability reasons of any type.

 

Sessions will be conducted either via cyber sessions (Facetime - Skype) or audio.

 

You are acknowledging that although every effort to protect confidentiality will be made,  

no guarantee of cyber security is made, nor is HIPPA compliance stated or implied.

 

You are agreeing to a partnered relationship with Susan Gross, LCSW, and the outcome of our work will be dependent on our joint efforts and appointment consistency of both parties.