Client Forms

If you are new, feel free to fill out these intake forms prior to our first session:

Client forms Download

Otherwise they can be completed at the first appointment as well.

Preliminary info form
Consent to treatment form
HIPPA statement of client rights and confidentiality form

Questions? Send a message

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Name

First

Last

Email

Phone

Comment or Message

Terms of use

Yes, I want to submit this form

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messages and wish to continue despite those risks. By selecting, “Yes, I want to submit this form”, you agree to hold Leanne N. Rodgers, Psy D., Licensed Clinical Psychologist harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Leanne N. Rodgers, Psy.D., PC

Client Forms

Questions? Send a message