Forms
Child Intake
intakechild2016.pdf | |
File Size: | 18 kb |
File Type: |
- Parents, please complete and sign this form for your minor child(ren).
Adult Intake
intakeadult2016.pdf | |
File Size: | 34 kb |
File Type: |
- Clients aged 18 and older, please complete and sign this form.
Informed Consent for Therapy
informed_consent-general.pdf | |
File Size: | 146 kb |
File Type: |
- A signature on the last page of this form is required for all clients. Adult clients and parents of minor children, please review the form and sign it.
- IMPORTANT: For divorced or separated parents, who share joint legal custody of minor child(ren), signatures are required by BOTH parents before Dr. Santoro will meet with your child(ren).
Informed Consent for Assessment
informed_consent-assessment.pdf | |
File Size: | 60 kb |
File Type: |
- A signature on the last page of this form is required for all clients. Adult clients and parents of minor children, please review the form and sign it.
HIPAA Notice
hipaa_notice_of_privacy_practices.pdf | |
File Size: | 94 kb |
File Type: |
- A signature on the last page of this form is required for all clients. Adult clients and parents of minor children, please review the form and sign it.
Professional Disclosure Statement
cm_prof_disc_stmt.pdf | |
File Size: | 35 kb |
File Type: |