Forms
Intake Form for Minors
Collects basic information about school, family, and social functioning, plus goals for therapy.
Document formats: Microsoft Word (DOCX), Adobe Acrobat (PDF)Consent Form
Allows Dr. Frank to provide therapeutic services. Includes information pertaining to therapy, record keeping, confidentiality, relevant legal matters, emergency contacts, and billing.
Document formats: Microsoft Word (DOCX), Adobe Acrobat (PDF)Notice of Privacy Practices
Describes how medical information about you may be used and disclosed, and how you can get access to this information.
Document formats: Adobe Acrobat (PDF)Release Form
Allows Dr. Frank to speak to people in the client’s life (e.g., former therapist, medical doctor, teacher, tutor).
Document formats: Microsoft Word (DOCX), Adobe Acrobat (PDF)Telehealth Consent Form
Permits therapy services to be provided via video conferencing.
Document formats: Microsoft Word (DOCX), Adobe Acrobat (PDF)Pandemic Consent Form
Permits in-person services during the COVID-19 public health crisis.
Document formats: Adobe Acrobat (PDF)
