Adult Intake Form

Please fill out this form and bring it to your first appointment. You can also fill out the form electronically and email it directly to your therapist if that’s easier for you.

Adult Intake Form and Privacy Policy

Child Intake Form

A parent or guardian should fill out this form and bring it to the child’s first appointment. You can also fill out the form electronically and email it directly to your therapist if that’s easier for you. If your child is 14 years old or older, they may complete the form themselves.

Child Intake Form and Privacy Policy

Julia Epstein, PMHNP Intake Forms

Informed Consent, Intake Form, and Privacy Policy

Mood Intake Form

Authorization for Release of Records, Informed Consent for Telehealth Visits, and Privacy Policy