New Patient Forms
ADULT CLIENTS: For your convenience, please print and complete the following forms prior to your first visit with Dr. Susan Mendelsohn.
- Intake: PDF or Online Form
- Disclosure Statement: PDF or Online Form
- Patient Information: PDF or Online Form
- Credit Card Permission Form
- Consent to Release
- Electronic Communications Consent Form: PDF or Online Form
- Consent for Returning to In-Person Psychological Services: PDF or Online Form
ADOLESCENT CLIENTS (Under age 18): Please print and complete the forms below and bring with you upon your initial appointment with Dr. Mendelsohn.
- Intake (For adolescent to complete): PDF or Online Form
- Adolescent Psychological Intake (For parent/guardian to complete): PDF or Online Form
- Disclosure Statement: PDF or Online Form
- Patient Information: PDF or Online Form
- Credit Card Permission Form
- Consent to Release
- Electronic Communications Consent Form: PDF or Online Form
- Consent for Returning to In-Person Psychological Services: PDF or Online Form
MARRIAGE AND RELATIONSHIP COUNSELING: Please print and complete the forms below and bring with you upon your initial appointment with Dr. Mendelsohn.
- NEW COUPLES QUESTIONNAIRE (Each person completes a separate questionnaire):PDF or Online Form
- New Couples Intake Form:PDF or Online Form
- Disclosure Statement: PDF or Online Form
- Patient Information: PDF or Online Form
- Credit Card Permission Form
- Consent to Release
- Electronic Communications Consent Form: PDF or Online Form
- Consent for Returning to In-Person Psychological Services: PDF or Online Form
EMOTIONAL SUPPORT ANIMAL (ESA): Please print and complete the forms below and bring with you upon your initial appointment with Dr. Mendelsohn.
- Intake: PDF or Online Form
- Disclosure Statement: PDF or Online Form
- Electronic Communications Consent Form: PDF or Online Form
