I am aware that my appointment is reserved for me. I agree to give twenty-four hours notice to
cancel my appointment. I agree to be financially responsible for paying for that session.
I also agree and authorize Mary Bondi to charge my credit card account for any and all unpaid
balances remaining outstanding for more than thirty (30) days after insurance payments have
been received; as well as for any scheduled appointments that have been cancelled, or broken,
without 24 hours prior notice (weekends do not apply). So, for instance, if you have a regular
Monday appointment time, you would need to cancel that appointment by the same time on
Friday of the preceding week.
Please complete the attached Payment Authorization Form.
I have read, understand, and agree with the entire contents of this form:
Printed Name of Client ______________________________________________________
___________________________________________________________________________
Signature of Client/Parent or Guardian (if under 18 year of age.)
___________________________________________________________________________
Name of Parent or Guardian if the patient is under 18 years old
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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THERAPY AGREEMENT
Client name: __________________________________________________________
Welcome, Please allow me to introduce you to this process with some general information regarding
your rights and responsibilities within this therapeutic relationship. I will also review and highlight my
responsibilities as a clinician in this process. I (we) understand that counseling services are strictly
confidential, with the following exceptions:
1) A legitimate subpoena by a court of law or a court order requiring the release of the information
specified by the subpoena or court order.
2) Statements of intent to harm oneself or another may result in the notification of the appropriate
authorities and/or intended victims.
3) Information concerning suspected child/disabled adult/elder abuse or neglect must be reported as a
mandated by: Florida statute 415.504 and 415.103.
4) Information regarding treatment of a minor without parental consent may be shared with the
parent(s), legal guardian(s), or legal authorities.
5) Supervision and case review.
All information concerning clients being seen by Mary L. Bondi LMHC, CHT, is to be kept strictly
confidential. Payment for services is due at the time service is rendered. Failure to pay for services may
result in the suspension or termination of services. Periodically our fee structure is reassessed to
accommodate cost of business operation increases. Those providing services will take all necessary
measures to collect outstanding balances. Full costs of any legal fees and expenses incurred by this
service provider will be the responsibility of the client.
*Cancellation of a scheduled appointment must be made at least 24 hours in advance of the appointment.
If this is not adhered to the client understands that he/she will be responsible for the full cost of the missed
appointment. * Office telephones are monitored throughout the day until 11:00 pm. nightly, 7 days a week
by an answering system. Any message left while the office is closed, is date and time stamped and will be
responded to on an as needed prioritization basis. In the event of an emergency if you cannot reach Mary
Bondi please dial 911 or go to your nearest Hospital.
I hereby willingly authorize Mary L. Bondi LMHC, CHT to maintain and/or retain any and all of my
records relating to the services I receive from her office, including without limitation; evaluation,
psychotherapeutic and/or case management services. I (we) understand and agree to the above
conditions.
___________________________________________________________________________________
Client(s)/ Parent(s)/ Legal Guardian(s) Signature
Date
___________________________________________________________________________________
Clinician Signature
Date
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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CANCELATION POLICY
I am aware that my appointment is reserved for me. I agree to give twenty-four hours notice to
cancel my appointment. I agree to be financially responsible for paying for that session.
I also agree and authorize Mary Bondi to charge my credit card account for any and all unpaid
balances remaining outstanding for more than thirty (30) days after insurance payments have
been received; as well as for any scheduled appointments that have been cancelled, or broken,
without 24 hours prior notice (weekends do not apply).
So, for instance, if you have a regular Monday appointment time, you would need to cancel that
appointment by the same time on Friday of the preceding week.
Please complete the attached Payment Authorization Form.
I have read, understand, and agree with the entire contents of this form:
___________________________________________
Printed Name of Client
___________________________________________
Signature of Client/Parent or Guardian if under 18
___________________________________________
Name of Parent or Guardian if the patient is under 18 years old
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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THERAPY AGREEMENT
Client name: ______________________________________________________________
Welcome,
Please allow me to introduce you to this process with some general information regarding your
rights and responsibilities within this therapeutic relationship.
I will also review and highlight my responsibilities as a clinician in this process.
I (we) understand that counseling services are strictly confidential, with the following
exceptions:
1) A legitimate subpoena by a court of law or a court order requiring the release of the
information specified by the subpoena or court order.
2) Statements of intent to harm oneself or another may result in the notification of
the appropriate authorities and/or intended victims.
3) Information concerning suspected child/disabled adult/elder abuse or neglect must
be reported as a mandated by: Florida statute 415.504 and 415.103.
4) Information regarding treatment of a minor without parental consent may be
shared with the parent(s), legal guardian(s), or legal authorities.
5) Supervision and case review.
All information concerning clients being seen by Mary L. Bondi LMHC, CHT, is to be kept strictly
confidential. Payment for services is due at the time service is rendered. Failure to pay for
services may result in the suspension or termination of services. Periodically our fee structure is
reassessed to accommodate cost of business operation increases. Those providing services will
take all necessary measures to collect outstanding balances. Full costs of any legal fees and
expenses incurred by this service provider will be the responsibility of the client.
* Cancellation of a scheduled appointment must be made at least 24 hours in advance of the
appointment. If this is not adhered to the client understands that he/she will be responsible for
the full cost of the missed appointment.
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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* Office telephones are monitored throughout the day until 11:00 pm. nightly, 7 days a week by
an answering system. Any message left while the office is closed, is date and time stamped and
will be responded to on an as needed prioritization basis. In the event of an emergency if you
cannot reach Mary Bondi please dial 911 or go to your nearest Hospital.
I hereby willingly authorize Mary L. Bondi LMHC, CHT to maintain and/or retain any and all of
my records relating to the services I receive from her office, including without limitation;
evaluation, psychotherapeutic and/or case management services.
I (we) understand and agree to the above conditions.
X
Client(s)/ Parent(s)/ Legal Guardian(s) signature
Date
X
Clinician Signature
Date
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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M.A.S.T. SCREENING TEST
DATE: ___________________________ NAME: _____________________________
SCORE:__________________________ M.R.NO:____________________________
YES
NO
1. Do you feel you are a normal drinker or chemical user?
(by normal, we mean do you drink or use mood-altering
chemicals less than or as much as most other people.)
___
___
2. Have you ever awakened the morning after some
drinking or drug usage the night before and found
that you could not remember a part of the evening?
___
___
3. Does your wife, husband, parent, significant other,
child, or concerned other ever worry or complain
about your drinking or chemical use?
___
___
4. Can you stop drinking or drug use without a struggle?
___
___
5. Do you ever feel guilty about your drinking or
chemical use?
___
___
6. Do friends or relatives think you are a normal drinker
or chemical user
___
___
7. Are you able to stop drinking when you want to?
___
___
8. Have you ever attended a meeting of alcoholics
Anonymous?
___
___
9. Have you ever gotten into physical fights when
drinking or drugging?
___
___
10. Has drinking or chemical use ever created
problems between you and your wife, husband,
significant other, or other close relatives?
___
___
11. Has your wife, husband, significant other,
parent, or other near relative ever gone to anyone
for help about your drinking or drug usage?
___
___
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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12. Have you ever lost friends, girlfriends or boy
friends, because of your drinking or drug usage?
___
___
13. Have you ever gotten into trouble at work
because of your drinking or drug usage?
___
___
14. Have you ever lost a job because of drinking
or drug use?
___
___
15. Have you ever neglected your obligations
(responsibilities), your family or your work for more
then 2 days in a row because you were drinking or
using drugs?
___
___
16. Do you drink or use drugs before noon fairly often?
___
___
17. Have you been told you have liver trouble?
Cirrhosis?
___
___
18. After heavy drinking or drug use have you ever had
delirium treatment (DTs) or severe shaking, or heard
voices or seen things that weren’t really there?
___
___
19. Have you ever gone to anyone for help about your
drinking or chemical usage?
___
20. Have you ever been in a health care facility, i.e
hospital, mental health center, because of drinking
or using drugs?
21. Have you ever been a patient in a psychiatric hospital
or in a psychiatric ward of a general hospital where
drinking/ drugging was part of the problem that
resulted in hospitalization?
22. Have you ever been a patient in a psychiatric or
mental health clinic or gone to any doctor,
social work, or clergyman for help with any
emotional problem, where drinking/drugging was
part of the problem?
___
___
___
___
___
___
___
23. Have you ever been arrested for drunken driving,
driving while intoxicated, or driving under the
influence of alcoholic beverages or other
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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mood-altering chemical? (If yes, How many times?)
___
___
24. Have you ever been arrested, even for a few hours,
for drunken behavior or drug usage behavior.
(If yes, How many times?)
___
___
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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NOTICE OF PRIVACY PRACTICES
AND HIPPAA AUTHORIZATION
As required by the Privacy Regulations Created as a Result of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA)
Our Legal Duty
Our practice is dedicated to maintaining the privacy of your individuality identifiable health
information (IIHI). In conducting our business, we will create records regarding you and the
treatment and services we provide for you.
We are required by law to maintain the confidentiality of health information that identifies you.
We also are required by law to provide you with this notice of our legal duties and the privacy
practices that we maintain in our practice concerning your IIHI. By federal and state law, we
must follow the terms of the notice of privacy practices that we have in effect at the time.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment and healthcare
operations. We will always use the minimum amount of information necessary. For example:
Treatment: We may use or disclose your health information to a physician or other healthcare
provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we
provide to you.
Your authorization: In addition to our use of your health information for treatment and/ or
payment you may give us written authorization to use your health information to disclose it to
anyone for any purpose. If you give us any authorization, you may revoke it in writing at any
time. Your revocation will not affect any use or disclosures permitted by your authorization
while it was in effect. Unless you give us a written authorization, we cannot use or disclose your
health information for any reason except those described in this Notice.
Your Family and Friends; We must disclose your health information to you, as described in the
Patient Rights section of time Notice. We may disclose you health information to a family
member, friend or other person to the extent necessary to help with your healthcare or with
payment for your healthcare, but your healthcare, but only if you agree that we may do so. You
may notify us verbally.
Persons Involved In Care: We may use or disclose health information to notify, or assist in the
notification of (including identifying or locating) a family member, your personal representative
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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or another person responsible for your care, of your location, your general condition, or death.
If you are present, then prior to use of disclosure of your health information we will provide you
with an opportunity to object to such uses or disclosures. In the event of your incapacity or
emergency circumstances, we will disclose health information based on a determination using
our professional judgment disclosing only health information that is directly relevant to the
person’s involvement in your healthcare.
We will also use our professional judgment and our experience with common practice to make
reasonable inferences of your best interest in allowing a person to pick up health information
for you.
Marketing Health-Related Services: We will not use your health information for marketing
communications.
Judicial and Administrative Proceedings: Your health information maybe disclosed for the
purposes of a judicial or administrative proceeding only when accompanied by a court or
administrative order or grand jury subpoena.
Abuse of Neglect: We may disclose your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the
possible victim of other crimes. We may disclose your health information to the extent
necessary to avert a serious threat to your health or safety of others.
National Security: We may disclose to military authorities the health information of Armed
Forces personnel under certain circumstances. We may disclose to authorized federal officials
health information required for lawful intelligence, counterintelligence and other national
security activities. We may disclose to correctional institution or law enforcement official
having lawful custody of protected health information of inmate or patient under certain
circumstances.
PATIENT RIGHT:
Access: You have the right to look at or get copies of your (or your child’s) health information,
with limited exceptions. Both parents may have access to a child’s health information unless
there is legal documentation otherwise. We will charge you a reasonable cost-based fee for
expenses for copies.
Alternative Communications: You have the right to request that we communicate with you
about your health information by alternative means or to alternative locations. (You must make
your request in writing.) Your request must specify the alternative means or location, and
provide satisfactory explanation how payments will be handled under the alternative means or
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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location you request. Our office policy is to contact you at all the phone numbers you have
provided us, and to leave messages on recorders. It is also our policy to send cards, newsletters
or other mailings.
In order for medical provider to release “Psychotherapy Notes” to a third party, the client who is
the subject of the Psychotherapy Notes must sign this authorization to specifically allow for the
release of Psychotherapy Notes.
Such authorization must be separate from an authorization to release other medical records.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT MARY L. BONDI,
LMHC,CHT. AT 954-467-2500.
Our office respects your right to privacy and your health information will be used only in the
ways that you want it to be used. We will do our best to accommodate your wishes, and to
protect your right to privacy. Thank you.
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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NOTICE OF PRIVACY PRACTICES
PATIENT RECEIPT AND ACKNOWLEDGEMENT OF NOTICE
Client name: _______________________________________________________
Date of birth: ____________________________
Social Security Number: __________________________________________
I hereby acknowledge that I have received a copy of/and have been given an opportunity to
read the full Notice of Privacy Practices for The counseling Office of Mary L. Bondi, LMHC, CHT.
I understand that if I have any questions regarding the Notice of my Privacy Rights, I can
contact Mary L. Bondi, LMHC at 954-467-2500.
X
Signature of Patient/Client
Date
X
Signature of Parent, Guardian or personal Representative*
Date
*If you are signing as a Personal Representative of an individual, please describe your legal
authority act on behalf of this individual (power of attorney, healthcare surrogate, etc.)
___________________________________, Patient/Client refuses to acknowledge receipt:
X
Signature of Staff Member
Date
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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PATIENT VITALS & INITIAL INTERVIEW
Date: _________________________
D.O.B: _______________________
Client Name:
_____________________________________________________________________________
Address:
________________________________________________________________________________
____________________________________________________________________________
Employer or School:
______________________________________________________________________________
Occupation:
_____________________________________________________________________________
Business Address:
_____________________________________________________________________________
Home Telephone:
_____________________________________________________________________________
Business Telephone:
_____________________________________________________________________________
Email Address:
_____________________________________________________________________________
Social Security Number:
_____________________________________________________________________________
Referral Source:
____________________________________________________________________________
Person to Contact in Emergency:
_____________________________________________________________________________
Address of Person:
_____________________________________________________________________________
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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Telephone Number:
_____________________________________________________________________________
Medical Insurance Provider:
_____________________________________________________________________________
ID or Group Number:
________________________________________________________________________
Current Medical Physician (name, address and phone):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________
Date of Last Visit/Exam:
________________________________________________________________________
Current Medications:
________________________________________________________________________
Current Nutritional Supplements:
________________________________________________________________________
Past/Present Medical Problems:
________________________________________________________________________________
________________________________________________________________
Have you ever been seen by a psychiatrist/ psychologist/ psychotherapist or addiction
counselor? Please describe:
________________________________________________________________________________
________________________________________________________________
Have you ever been hospitalized for emotional/psychiatric and/or alcoholism/addiction
problems? Please describe:
________________________________________________________________________________
________________________________________________________________
Please state name of Hospital (S):_______________________and Year:___________
Alcohol and Drug Use:
____________________________________________________________
Do you see yourself as being a compulsive eater or having an eating disorder?
________________________________________________________________________
Relationship Status: Single( ) Married( ) Living In Intimate Relationship( ) Separated( )
Divorced( ) Widowed( ) How Long?
________________________________________________________________________________
________________________________________________________________
How many people live in your home?
________________________________________________________________________
Does anyone in your household present a problem?
________________________________________________________________________
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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Has there been any violence in your home?
________________________________________________________________________
If you have children, please state name and ages:
________________________________________________________________________________
________________________________________________________________
Parents Living: (Father) Yes__ No__ (Mother) Yes__ No__
Name and Age
(Father): __________________________ (Mother)__________________________
Hometown:
________________________________________________________________________
Siblings, Names and Ages:
________________________________________________________________________
How was growing up for you?
________________________________________________________________________
________________________________________________________________________
How would you describe yourself as a teenager?
________________________________________________________________________________
________________________________________________________________
At what age did you leave home and why?
________________________________________________________________________________
________________________________________________________________
What was school like for you?
________________________________________________________________________
Ever expelled or suspended?
________________________________________________________________________
Last grade completed and reason for leaving?
________________________________________________________________________________
________________________________________________________________
Circle any of the following symptoms that may apply to you:
Insomnia
Nightmares
Appetite
Palpitations
Alcoholism
Taking Drugs
Depressed
No
Physical Pain
Weight Loss/Gain
Memory Problems
Dizziness
Financial Difficulties
Suicidal Ideation
Fatigue
Feeling Tense
Stomach Troubles
Sexual Difficulty
Inferiority Feelings
Difficulties with
Concentration
Difficulty making Friends
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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Are there any other areas of concern which need to be addressed in therapy?
________________________________________________________________________________
________________________________________________________________
Presenting problems:
1)______________________________________________________________________
2)______________________________________________________________________
3)______________________________________________________________________
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Tentative diagnosis:
________________________________________________________________________
Referred for Psychiatric evaluation:
________________________________________________________________________
X______________________________________________________________________
MARY L. BONDI
I am consenting to psychotherapy treatment with Mary L. Bondi LMHC.
X______________________________________________________________________
(SIGNATURE OF CLIENT
AUTHORIZATION FOR USE OR DISCLOSURE OF
PROTECTED HEALTH INFORMATION
1. Clients Name: _______________________________________________________
First Name
Middle Name
Last Name
2. Date of Birth: ___/___/___
3. Date authorization initiated: ___/___/___
4. Authorization initiated by: _____________________________________________
5. Information to be released:
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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o
o
Authorization for Psychotherapy Notes ONLY
(Important: If this authorization is for Psychotherapy Notes, you
must not use it as an authorization for any other type of protected
health information.)
Other (describe information in detail):
6. Purpose of Disclosure:
_____________________________________________________________________
7. Person (s) Authorized to Make the Disclosure:
_____________________________________________________________________
8. Person (s) Authorized to Receive the Disclosure:
_____________________________________________________________________
9. This Authorization will expire on ___/___/___
or upon the happening of the following event:
_____________________________________________________________________
Authorization and Signature: I authorize the release of my confidential protected health
information, as described in my directions above. I understand that this authorization is
voluntary, that the information to be disclosed is protected by law, and the use/disclosure to be
made to conform to my directions. The information that is used and/or disclosed pursuant to
this authorization may be redisclosed by the recipient unless the recipient is covered by state
law that limit the use and/or disclosure of my confidential protected health information.
Signature of the patient: _________________________________________________
Signature of Personal Representative: ______________________________________
Relationship to Patient if Personal Representative: ___________________________
Date of Signature: ___________________________
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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LIMITS OF CONFIDENTIALITY
Contents of all therapy sessions are considered to be confidential. Both verbal information and
written records about a client cannot be shared with another party without the written consent
of the client or client’s legal guardian.
Noted exceptions are as follows:
Duty to Warn and Protect
When a client discloses intentions or a plan to harm another person, the mental health
professional is required to warn the intended victim ad report this information to legal
authorities. In cases in which the client discloses or implies a plan for suicide, the health care
professional is required to notify legal authorities and make reasonable attempts to notify the
family of the client.
Abuse of Children and Vulnerable Adults
If a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently
abused a child (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the
mental health professional is required to report this information to the appropriate social
service and/or legal authorities.
Parental Exposure to Controlled Substances
Mental Health care professionals are required to report admitted prenatal exposure to
controlled substances that are potentially harmful.
Minors/Guardianship
Parents or legal guardians of non-emancipated minor clients have the right to access the
clients’ records.
Insurance Providers (when applicable)
Insurance companies and other third-party payers are given information that they request
regarding services to clients. Information that may be requested includes type of services,
dates/times of services, diagnosis, treatment plan, and description of impairment, progress of
therapy, case notes, and summaries.
I agree to the above limits of confidentiality and understand their meanings and ramifications.
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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________________________________________________________________________
Printed Name of Client
________________________________________________________________________
Signature of Client/Parent or Guardian if under 18
________________________________________________________________________
Name of Parent or Guardian if the patient is under 18 years old
Confidentiality – Your privacy is extremely important to me and for or work together. What you
disclose to me is generally protected by laws and ethics.
I need your permission before I may release any information concerning your treatment, except
under the following circumstance:
1. If there is a reasonable suspicion of abuse/neglect of a child, elderly, dependent, or
disabled person.
2. If you may be in danger of harming yourself or another person.
3. As required by a third-party to obtain reimbursement.
4. As otherwise ordered or required by law (for example, as a result of a court order).
This form does not cover every possible exception. Please refer to the HIPPAA
Notice of Privacy Practices, which we supplied you.
Additional Charges – Any additional charges may be assessed for services other than therapy in
session as needed.
Legal Procedures – If you become involved in legal proceedings, payment is required for all
professional time spent. A legitimate subpoena by a Court of Law or a Court order requiring the
release of the information specified by the subpoena or court order. Including preparation
travel (and cost) even if I am called to testify by a third party.
Due to the difficulty of legal involvement, I charge $250.00 per hour for participation and
attendance at most legal proceedings.
If I am required to appear in court, my fee is $350.00 per hour, with a minimum of three hours.
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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Supervision and Case Review – There may come a time where I will share some information
about our work together. I may discuss your treatment in consultation with other Associates or
I may share aspects in teaching interns.
I have read this agreement, understand it, and have had my questions answered. I accept,
understand, and consent to participate in treatment.
Client
_________________________________
Print name
Clinician:
_________________________________
Print Name
_________________________________
_________________________________
Signature
Date
Signature
_________________________________
Signature of Client/Guardian if Applicable
_________________________________
Print Name of Parent or Guardian
Only if patient is under 18 years old
Date
Date
Date
4901 NW 17 Way - Suite 408 - Fort Lauderdale, Florida 33309 T: 954-467-2500 F: 954-491-1551 MaryBondi.com
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