Please click on each form to view and download. Print, sign and bring these to your initial appointment.

If you have any questions or concerns, feel free to contact me prior to your appointment.

 

Forms for Child/Teen Clients

Informed Consent for Psychotherapy - click here to view and download

Consent for Treatment of a Minor - click here to view and download

Adolescent Assent Form - click here to view and download

Child/Adolescent Intake Form - click here to view and download

HIPAA Notice of Privacy Practices - click here to view and download


Forms for
Adult Clients

Informed Consent for Psychotherapy - click here to view and download

Adult Intake Form - click here to view and download

HIPAA Notice of Privacy Practices - click here to view and download

 

Iā€™m looking forward to meeting you!

-Dr. Madeline Polonia