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Helpful Forms

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.

Enimga First Visit Forms

Note: To download Adobe Acrobat Reader for free, click here.

 

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE