Forms for your first visit
You can download forms to bring with you to your first visit and save time in the waiting room. I can always provide them for you when you come, but you may want to come a few minutes early. Just let me know, and I will leave forms out for you!
Intake Forms for Abigail Burd, LCSW
To read and keep for your files: “Notice of Privacy Practices”:
Notice of Privacy Practices_Abigail Burd, LCSW
Update for all forms: I no longer need your social security number. Please leave that line blank.
Please PRINT, COMPLETE AND BRING WITH YOU: “Receipt and Acknowledgment of Notice”:
Receipt Acknowledgment Of Notice_Abigail Burd,LCSW
and “Client Information Form”:
Client Information_Abigail Burd, LCSW.
Optional form that may be useful.
If there is another professional or a family member that you would like me to be able to talk to, this “Release of Information” form may be needed:
Release of Information_Abigail Burd, LCSW