Before Our First Appointment

So as to minimize the time we must spend addressing administrative matters, please download the federally mandated forms listed below, review them, and bring in the relevant pages to our first session. 


 

Client Info Form.docx Client Info Form.docx
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Type : docx
Client Info Form.pdf Client Info Form.pdf
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Type : pdf

1. Client Info Form: Please complete this form and bring it with you to the appointment. With the version on the left you may type directly into the form before printing. If you are unable to open a docx file, please print out the pdf version on the right. 

HIPAA Notice 2016.pdf HIPAA Notice 2016.pdf
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2. HIPAA Notice (Health Insurance Portability and Accountability Act), which all health providers must give to their patients. If you are unfamiliar with the HIPAA Notice, please read it. Please sign the last page and bring that page with you to the appointment.  

Therapy Agreement.pdf Therapy Agreement.pdf
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3. Psychotherapy Agreementwhich explains my office policies and relevant laws about confidentiality in more detail. Please read this agreement, sign the last page and bring that page with your to the appointment.


Robin S. Rosenberg, Ph.D., ABPP
Clinical Psychologist

Offices in:
  • Mission/Noe Valley, San Francisco
  • Menlo Park, California

650-206-9636
Mailing address: 
800 Menlo Avenue; Suite 121
Menlo Park, CA 94025

 
Cal. Lic. #24085                       
Mass. Lic. #4604
NY Lic. #021395