Laurie Leventhal-Belfer, PhD
https://www.asdcollegebook.com
  • About
    • About Dr. Laurie
    • Philosophy
    • Specialties
    • Testimonials
  • Services
    • General
    • The Friends Program >
      • Overview
      • Introductory Video
      • Nuts & Bolts
      • Friends Program Services
      • Friends Calendar
      • Middle School Group
      • Summer Program
      • Friends Group Posters
      • Staff
      • FAQ
    • 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

The Friends Program Consent Form:  PDF  |  MS Word

The Friends Summer Program Application:  PDF  |​  MS Word

General

HIPAA Notice of Privacy Practice: PDF
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E-mail Authorization:  PDF  |  MS Word
Copyright © 2014-2023 · Laurie Leventhal-Belfer, Ph.D.· All rights reserved.
  • About
    • About Dr. Laurie
    • Philosophy
    • Specialties
    • Testimonials
  • Services
    • General
    • The Friends Program >
      • Overview
      • Introductory Video
      • Nuts & Bolts
      • Friends Program Services
      • Friends Calendar
      • Middle School Group
      • Summer Program
      • Friends Group Posters
      • Staff
      • FAQ
    • Intake Forms
    • Rates and Insurance
  • Publications
    • College on the Autism Spectrum
    • All Books
  • Media
  • Resources
  • Contact