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Practice Forms

Prior to being seen for the first visit, clients will need to complete the following forms.  They take 15-20 minutes to complete.  You can print these forms in advance or arrive early to complete them.  Either way, it is necessary for them to be completed prior to beginning treatment.
- to be filled out by all new clients

Psychologist-Client Agreement - to be filled out by all new clients

Notice of Privacy Practices - to be filled out by all new clients

Client Information Packet - to be filled out by all new clients

Authorization of Insurance Benefits – applies only to Highmark Blue Shield / Blue Card PPO members 

Authorization to Communicate With Your Referring Health or Mental Health Provider 

SmegelBook

Dr. Spiegel's new book!

"This is the first well-informed and scientifically rigorous extension of attachment theory to group psychotherapy. It is a wonderfully constructed and imaginative text that is sure to become a clinically invaluable tool for all those who work with groups and an excellent introduction to students learning the art of psychological treatment."

— Peter Fonagy, PhD, FBA, Chief Executive of the Anna FreudCentre, and Freud Memorial Professor of Psychoanalysis, University College London, England

Order your copy here!

 

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