top of page

​

If you're a new client, please complete the following forms and bring them to your first therapy session.

​

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:


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

​

Lake City, FL 32025
email:
heartcentered@shaledamirralcsw.com

Dr. Sha'Leda Mirra, PhD, M.Div., MS, LCSW, CAP

(352) 247-2383

Book Me for your next Mental Wellness Workshop!

bottom of page