Forms

Biological Dental Resources and Mercury Amalgam information.If you're a new client, please complete the following forms and bring them to your first therapy session.

• Client Psychotherapy Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

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

Dental Emergency Strategizing Resources -- Biological Dental Treatments

• Call the dentist i've written down for you.
• Or Dr. Mark McClure at National Integrated Health Associates (NIHA) at: 202-237-7000, Press 2 for Dental Team information tree. 
• Background for choosing your strategy: IAOMT International Academy of Oral Medicine and Toxicology.
• Do you have "silver" fillings? These are actually 15% Silver and 52% Mercury. Sadly Mercury is known to vaporize out and be swallowed and migrate into the brain. Read on this Resources page from IAOMT.
• Charts that may help explain unusual symptoms sometimes extreme mania or near inactivity:
  1. Dental Tooth-Organ chart [includes Organs and Emotions associated with the Acupuncture energy circuit through that tooth.].
     1. tooth-organ-emotion-acupuncture-dental-correlations-chart.pdf