Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session. If you are interested in telepsychology, please email [email protected] (HIPAA compliant email) with your insurance card, date of birth, new patient intake forms as well as informed consent for telepsychology. Dr. Soliman will determine if the referral is an appropriate fit for telepsychology via email.

Helpful Forms

Adult Intake Packet

Adult Intake Packet- Spanish

Permission to Exchange Info (ROI)

COVID-19 Consent

Informed Consent for Telepsychology

HIPAA NPP Form

Insurance Acknowledgement

No Surprise Act/ Good Faith Estimate (Private Pay Only)

Child Intake Packet

Couples Therapy Intake

Couples Therapy Consent

Couples Therapy Intake- Spanish

Couples Therapy Consent- Spanish

Family Intake Form

Family Intake Form- Spanish