For Smoking Cessation and Weight Loss Clients

No forms are needed before your first visit.  Insurance is not accepted for these services.

Weight loss and smoking cessation are not covered by insurance and are covered by cash, check or credit card ONLY.

For Counseling Clients Only

These forms are for therapeutic counseling clients only and are not for smoking or weight loss clients.  If you are visiting Robbie the first time for problems with Stress Management, Phobias, Chronic Pain or for help with other therapies, please complete one version of the forms. 

• The PDF is a printable form that you can complete by hand.
• The Word Document will allow you to open the file in MS Word, type into it and save it, then print it.  We recommend you save the file in your Documents folder or Desktop before you begin.  (Make sure you know where the file is saved.)

 PDF   or Word Document (MS Word Required)

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