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Peter Strisik, Ph.D.
Suzanne Strisik, Ph.D.
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For your convenience, we have put links to forms that we use in our practice on this page.  You can print the relevent forms to fill out prior to coming in for your first appointment.  You can also access forms here for authorizing release of information or for authorizing charges to a credit card.  Of course, we have these forms at our offices if you prefer to fill them out when you come in. 
 

Forms for the first appointment: 

Everyone should complete the relevant General Information form (Adult or Child) download and read the Privacy Notice, and read and sign the Agreement for Psychological Services form. 

If you have questions about any of the forms, please call or email and we will be glad to help.  Our contact information is on our home page.
 

Accessing the Forms:  In order to access these forms, you will need a recent version of the Adobe Acrobat Reader.  You may already have this program installed.  Try one of the form links.  If it doesn't work, you can download the latest version of the program here.  With the Acrobat Reader program installed, clicking on the form's link should display the form in a new browser window and you can print it. 

Dr. Peter Strisik's Forms

(These three for first appointment)

General Information (Adult) - Complete prior to your first appointment.  Couples: one form for each person.
Agreement for Psychological Services - To read before and sign before or at your first appointment.  Couples: one form for each person.
Privacy Notice - Required by federal law.  Notice regarding privacy of your medical information.  I will ask for your signature indicating that you have received this notice.
Optional Forms:
Authorization to Release Information - Only needed if you wish information to be released to someone else.
Credit Card Preauthorization - Only needed if you wish to use a credit card to pay for services.

Dr. Suzanne Strisik's Forms

(These three for first appointment)

General Information (for Adults) or
General Information (for Children)
Complete the appropriate form prior to the first appointment.  One adult form for each member of a couple or one child form for each child being seen.
Agreement for Psychological Services - To read before and sign before or at your first appointment.  Couples: one form for each person.
Privacy Notice - Required by federal law.  Notice regarding privacy of your medical information.  I will ask for your signature indicating that you have received this notice.
Optional Forms:
Authorization to Release Information - Only needed if you wish information to be released to someone else.
Credit Card Preauthorization - Only needed if you wish to use a credit card to pay for services.

 


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