Jo Anne Kaplan, MFT, Ph.D.

Below are forms you will need to fill out prior to commencement of services. You will need Adobe Acrobat Reader to open the files. Please fill out the forms to the extent you can and bring them with you at your scheduled appointment. Should you have any question(s) and/or concerns, please leave the part blank and bring the form to your appointment.

Please click the link below to open each document.  Once the document opens, you can input/type-in your information directly onto the form prior to printing.  However, signature and date of signature would still have to be handwritten. Please bring the forms to your first appointment.

Please note:  these forms have legal implication. If you have any questions, please bring the forms to your appointment and we would be more than happy to answer any questions you may have.

Client Information/Intake Form

Patient Consent Form

Notice of Privacy Policies

Receipt of Notice of Privacy Policies & Consent Form

Billing Information