Forms

Here you will find downloadable forms in Adobe PDF format. You will need a copy of Adobe Reader to open these files. Please print the appropriate forms, fill them out, and bring them with you to your scheduled appointment. All information is kept strictly confidential, and is stored securely.

Client Profile Form

This is a general information form, which asks for basic data such as your contact information, employment, and emergency numbers.

 

2 pages, 175 KB file size

Client Intake Form

On this form, you will provide more specific information about your needs, medical history, and health care.

 

2 pages, 199 KB file size

Consent for the Release of Confidential Information Form

By completing this form, you authorize Sharyn Schreiber Pinney, LCSW to obtain or release your personal evaluation and/or treatment information.

 

1 page, 180 KB file size

Fees & Cancellation Policy

This form outlines the current client fees, as well as the policy for cancelling appointments.

 

1 page, 71 KB file size