Laurie Leventhal-Belfer, PhD
  • About
    • About Dr. Laurie
    • Philosophy
    • Specialties
    • Testimonials
  • Services
    • General
    • Intake Forms
    • Rates and Insurance
  • Publications
    • College on the Autism Spectrum
    • All Books
  • Media
  • Resources
  • Contact

Forms


Adults

Adult Intake Form:  PDF  |  MS Word

​Consent to Exchange Information:  PDF  |  MS Word

Consent for Adult Psychological Services:  PDF  |  MS Word

Consent for Adult Psychological Services (Telecommunication Update):  PDF  |  MS Word

Adult Service Agreement:  PDF  |  MS Word
Picture

Children

Child's Intake Form:  PDF  |  MS Word

Consent to Exchange Information:  PDF  |  MS Word

Consent for Child's Psychological Services:  PDF  |  MS Word

Consent for Child's Psychological Services (Telecommunication Update): PDF  | MS Word

Divorce and Separation Contract:  PDF  |​  MS Word

General

HIPAA Notice of Privacy Practice: PDF
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E-mail Authorization:  PDF  |  MS Word
Copyright © 2014-2025 · Laurie Leventhal-Belfer, Ph.D.· All rights reserved.
  • About
    • About Dr. Laurie
    • Philosophy
    • Specialties
    • Testimonials
  • Services
    • General
    • Intake Forms
    • Rates and Insurance
  • Publications
    • College on the Autism Spectrum
    • All Books
  • Media
  • Resources
  • Contact