Diane Gleim
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For Clients

Curious about psychotherapy?  Need to fill out my forms?  See below

For Clients:
Individual Therapy - Generally sessions are 50 minutes long unless we make other arrangements.
Couples Therapy - Generally sessions are 50 minutes long unless we make other arrangements.

I do not accept insurance.  You may be able to get partial reimbursement from your health insurance company for our sessions. It is your responsibility to check with your specific insurance company to find out if you have an out-of-network benefit for mental health services.  If so, I can provide you with a statement (a.k.a. Superbill) for reimbursement.

For the Public:
I also give talks and lectures to organizations and the public on a variety of sexuality-related topics.  Please note that due to scheduling demands, I can only book one speaking engagement per month.
New Client Paperwork:
​Once we have scheduled an appointment I ask all new clients, including initial assessments, to complete the forms below.  If any question is confusing or does not apply to you, simply leave it blank.
Client Contact Sheet
File Size: 35 kb
File Type: pdf
Download File

Informed Consent
File Size: 75 kb
File Type: pdf
Download File

General Questionnaire
File Size: 54 kb
File Type: pdf
Download File

Sexual Health Questionnaire
File Size: 67 kb
File Type: pdf
Download File

Authorization to Release Confidential Information
File Size: 37 kb
File Type: pdf
Download File

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