LET’S GET STARTED Welcome to the Center for Anxiety. We are caring clinicians, working and growing together to provide effective outpatient and intensive treatment to make a difference in the communities that we serve. Our core values are to go the extra mile for our patients, to be highly skilled and effective, to work collaboratively and support one another, and to continuously strive to learn and grow past our perceived limits. We take these values seriously. If you have any feedback about your treatment, positive and/or negative, please don’t hesitate to reach out to me personally by email at [email protected] Please read this message carefully as it contains important information about our clinical and administrative procedures. If you have any questions, please call our office at 646.837.5557 Please complete the following forms prior to your intake session: 1) Informed Consent 2) Release of Information 3) Medicare Disclosures 4) Credit Card Authorization Form In order to develop an effective treatment plan and track your progress over the course of treatment, all Center for Anxiety patients complete an online questionnaire during the intake process, and before each session. This allows our clinicians to quantify and better understand your clinical needs, track your progress over time, and help you achieve your goals. The platform we use to administer these clinical questionnaires is called Psych-Surveys. You will receive an automatic email prior to each session with a link to a questionnaire. The intake questionnaire takes about 30 minutes to complete, and the weekly questionnaire takes 2-5 minutes to complete, though these times are just average times and will vary from patient to patient. Thank you for trusting the Center for Anxiety with your care. All my best, David H. Rosmarin, PhD, ABPP Founder/Director, Center for Anxiety Assistant Professor, Harvard Medical School Today's Date* MM slash DD slash YYYY Patient Name:* Patient Last Name:* Date of Birth* MM slash DD slash YYYY Email Address A copy of the intake forms will be sent to this email address.Parent/Legal Guardian First Name Parent/Legal Guardian Last Name I am this patient's parent/legal guardian I am this patient's parent/legal guardian (please do not select if patient is over 18 years of age) LET’S GET STARTED Please fill out the information below to start the process. Welcome to the Center for Anxiety. We are caring clinicians, working and growing together to provide effective outpatient and intensive treatment to make a difference in the communities that we serve. Our core values are to go the extra mile for our patients, to be highly skilled and effective, to work collaboratively and support one another, and to continuously strive to learn and grow past our perceived limits. We take these values seriously. If you have any feedback about your treatment, positive and/or negative, please don’t hesitate to reach out to me personally by email at [email protected] Please read this message carefully as it contains important information about our clinical and administrative procedures. If you have any questions, please call our office at 646.837.5557 Please complete the following forms prior to your intake session: 1) Informed Consent 2) Release of Information 3) Medicare Disclosures 4) Credit Card Authorization Form In order to develop an effective treatment plan and track your progress over the course of treatment, all Center for Anxiety patients complete an online questionnaire during the intake process, and before each session. This allows our clinicians to quantify and better understand your clinical needs, track your progress over time, and help you achieve your goals. The platform we use to administer these clinical questionnaires is called Psych-Surveys. You will receive an automatic email prior to each session with a link to a questionnaire. The intake questionnaire takes about 30 minutes to complete, and the weekly questionnaire takes 2-5 minutes to complete, though these times are just average times and will vary from patient to patient. Thank you for trusting the Center for Anxiety with your care. All my best, David H. Rosmarin, PhD, ABPP Founder/Director, Center for Anxiety Assistant Professor, Harvard Medical School Today's Date* MM slash DD slash YYYY Patient Name:* Patient Last Name:* Date of Birth* MM slash DD slash YYYY Email Address A copy of the intake forms will be sent to this email address.Parent/Legal Guardian First Name Parent/Legal Guardian Last Name I am this patient's parent/legal guardian I am this patient's parent/legal guardian (please do not select if patient is over 18 years of age)
