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Peter Strisik, Ph.D.
Suzanne Strisik, Ph.D.
About Psychotherapy
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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 relevant forms to complete prior to 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 General Information form, read and sign the Agreement for Psychological Services and Agreement for Online Services forms, and read and keep the HIPAA Privacy Notice.  Fill out the Credit Card Preauthorization only if you with to use a credit/debit card for fees.

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. Suzanne Strisik's Forms

(These four for first appointment)

General Information (for Adults)
Complete prior to the first appointment.  One adult form for each member of a couple.
Agreement for Online Services - To read before and sign before or at 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.  Your signature on the Agreement for Psychological Services form will indicate 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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Copyright 2002 - Peter Strisik, Ph.D. & Suzanne W. Strisik, Ph.D.
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