Please download the corresponding forms prior to your initial appointment. Many of the forms can be emailed back to your clinician or you can print them out and bring them with you to the office. While we do not participate with any insurance carriers, we provide a guide to walk you through what questions to ask. Note that all new clients should fill out the forms under their clinician’s name as well as that heading and then any additional forms as they might be relevant.

Julie Bindeman, Psy-D

All New Clients

• policies
• intake
  
•  questions to ask your insurance company
•  release
•  credit card authorization
•  telehealth consent form

New Parents

• new parent intake
• postpartum mood screening

Fertility Evaluations

•  Contact Dr. Bindeman for specific forms
• release
  

nanci brown, lcsw-c

    all new clients

        policies

        intake

        questions to ask your insurance

        release

        credit card
couples

        initial surveys (for both to complete separately)

    new mom

        intake

        edinburgh post-partum depression scale

    infertility

         release

         informed consent 1

         informed consent 2

kari moskowitz, phd

   all new clients

       policies

        general intake form

        consent to treat

        Questions to ask your insurance company

        release form

        credit card authorization

dahlia topolosky, psy-d

   all new clients

        policies

        general intake form

        consent to treat

        Questions to ask your insurance company

        release form

        credit card authorization

        telehealth consent form

    assessment

        adult intake form
        childhood history form

        childhood symptoms checklist

        testing day guidelines

    Cogmed

            fact sheet

          credit card form for Cogmed

          rating scale (7-17)
rating scale (18+)

sam allen, ms lgmft

    all new clients

        policies

        general intake form

        questions to ask your insurance company

        release form

        credit card authorization

*please contact Sam Allen for additional forms he might require

karen epstein, lgpc

    all new clients

          policies

        general intake form

        questions to ask your insurance company

        release form

        credit card authorization

    teens

           intake form

ITGW group forms

        group policies

        intake

        questions to ask your insurance company

        release

        credit card authorization