Patient Forms

Before your appointment Please read and fill out the following forms before your first meeting. 

 

To download all forms in the original format, please click 'DOWNLOAD ALL FORMS' button below. 

 

If you are a new client you can review and complete the following forms and bring them with you to your first session:

 

After the form opens, you may save it in your computer by clicking the 'Save As' button on your browser. You may also print them directly from your computer by selecting 'Print'.

Confidentiality

All information between therapist and patient is held strictly confidential unless:

1. The patient authorizes the release of information with his/her signature.

2. The patient presents a physical danger to self.

3. The patient presents a physical danger to others.

4. Child/elder abuse/neglect is suspected. In the latter two cases, I am required by law to inform potential victims and legal authorities so that protective measures can be taken.

 

Financial Terms

Fees will be discussed before beginning treatment. Dr. Baron does not take any insurance but will provide a Superbill to the patient for submission to his/her insurance provider for reimbursement.

 

Canceled/Missed Appointments

A scheduled appointment means that time is reserved only for you. If an appointment is missed or canceled with less than 24 hours notice, the responsible party will be billed according to the scheduled fee.

 

Consent for Treatment

I further authorize and request that Dr. Stephanie R. Baron, Ph.D. carry out psychological examinations, treatments and/or diagnostic procedures that now or during the course of my care as a patient are advisable. I understand that the purpose of these procedures will be explained to me upon my request and Subject to my agreement. I also understand that while the course of therapy is designed to be helpful, it may, at times, be difficult and uncomfortable.

Thanks for submitting!