Lauren B. Yerkes, Psy.D.

Licensed Clinical Psychologist

Client Forms

Notice of Privacy Practices

Please read and review. Printing this form is optional. 

Receipt of Notice of Privacy Practices

Please print and complete after reviewing the Notice of Privacy Practices to bring to your first session.

Office Policies and Procedures

Please print and complete to bring to your first session. 

New Client Intake Form

Please print and complete to bring to your first session.

Telehealth Consent Form

Please print, sign, and return prior to first telehealth appointment.

Consent to Release of Information

This form is necessary only if you would like to grant me permission to release confidential information to another person, provider, or agency.

Please print and complete one form for each person/agency if you would like to grant this permission.

 

Current Client Updated Information Form

This form is for current clients only who need to update their information.  Please print, sign, and bring to session.

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