If you're a new client to Dr. Blumberg's St. Margaret's Bay practice, please complete the following forms and bring them to your first therapy session.
- Client Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
- Authorization to Disclose Information Form
|Client Psychotherapy Intake Form|
|Limits of Confidentiality/Therapy Cancellation Policy|
|Authorization to Disclose Information Form|
For new clients seeing Dr. Blumberg through the Enigma Mental Health Studio in Clayton Park, please complete the following documents instead of the above and bring them to a first visit.
Note: To download Adobe Acrobat Reader for free, click here.