New Client Documents

Psychologically Speaking with Dr. Jack Singer, LLC

Please read these HIPPA forms and if you have no questions, please sign the signature page and fax it to me, along with the forms you fill out below (either the minor or adult forms).Thank you.

New Client Information Sheets Adults

New Client Information Sheets Minors

Instructions:

  1. Print form (2 pages)
  2. Fill in all information and sign
  3. Scan forms and email to drjack@askddrjack.com

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