Please find below a list of our older paper forms, in case you are unable to complete your form online.
If the client is under the age of 18,
please also complete the following forms
and bring them to your first session:
please also complete the following forms
and bring them to your first session:
Therapist Disclosure of Information Forms
Please click on the corresponding provider:
- Rebecca Brooks
- Jason Frishman
- Zachary Galkin
- David Ganapol
- Diane Gottlieb
- Jessica Horner
- Kathy Keating
- Megan Kiernan
- Marcy Milton
- Krista Reincke
- Scott Ward
- Shana Witkin
If you would like us to coordinate care with another provider
(for example, your psychiatrist, another program, primary care
physician, etc.), please complete this form to authorize the release
of psychotherapy information:
(for example, your psychiatrist, another program, primary care
physician, etc.), please complete this form to authorize the release
of psychotherapy information:
Note: To download Adobe Acrobat Reader for free,
click here
.