Terry A. Rifkin L.C.S.W.
THERAPY FOR INDIVIDUALS, COUPLES, & FAMILIES
New Patient Forms

I consider your time to be very valuable.  Please complete the forms below and bring them to my office for your first visit.   

  • Patient Intake Form
  • Patient Policy Statement

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Patient Intake Form
 
Patient Policy Statement
 
Authorization to Disclose Information Form  

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