Susanne McIntyre, Ph.D.

Psychotherapy and Evaluations for Children and Adolescents

Forms

Susanne McIntyre, Ph.D.
545 Saw Mill River Rd.
Ardsley, NY  10502
914-478-4461
sm@susannemcintyre.com

For new clients, please complete and print the Developmental History Form and either the Informed Consent to Child Psychotherapy OR Informed Consent to Diagnostic Evaluation.

Developmental History Form

Informed Consent to Child Psychotherapy Form
OR Informed Consent to Diagnostic Evaluation of a Child Form

To give consent for Dr. McIntyre to contact others who work with your child, such as a teacher, pediatrician, or tutor, please print out and complete the following:
HIPAA Authorization Form

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Susanne McIntyre, Ph.D.  •  914-478-4461  •  sm@susannemcintyre.com
Copyright © 2017 Susanne McIntyre