Our most current forms can now be completed online, and are found in our Confidential Patient Portal in Therapy Notes, available to potential new patients. Contact Dr. Schonberg for more information. The forms below provide a preview.
To view and print your PDF documents, you will need Acrobat Reader software which can be downloaded at no charge from Adobe.
- New Patient Demographic Information – click here
(For new patients to complete and bring to the first appointment.) - Statement of Understanding (Psychotherapy Agreement) – click here
(Adult or parent should sign the last page and bring to the office visit.) - Adult Evaluation Form – click here
(Adult Initial Evaluation for all new Adult Patients to complete and sign prior to appointment.) - Permission to Treat Child – click here
(For new child patients, parents signature required.) - Child Evaluation Form – click here
(For new child patients, parents complete.) - Health Information Protection and Portability (HIPPA) – click here
(These are the HIPPA regulations describing patient confidentially.) - Permission to Release Treatment Information – click here
- Medicare Agreement – click here
- Credit Card Authorization – click here