Download Forms and Documents

These forms provided information, disclosures, and agreements regarding informed consent for treatment, payment policies of the practice, and an intake questionnaire to fill out and bring with you to your first session.

1

Informed Consent for Treatment

Please read, review, print, and sign this form to bring to your first session.  Any questions about the informed consent may be asked during the initial consultation or the first session.

2

Notice of HIPAA Privacy Practices

Please review the privacy policies ("HIPAA") followed by this practice.  Again, please ask any questions you may have about this document during the initial consultation or the first session.  You do not need to print or sign this form; instead, you will sign the acknowledgement form below that you have reviewed this document.

3

Acknowledgement of Receipt of Privacy Practices

Please read, review, print, and sign this form to acknowledge that you have received a copy of the practice's HIPAA Privacy Practices and had an opportunity to ask any questions about it.  You may bring it with you to the first session.

4

Individual Therapy Intake Questionnaire

Please complete this form for individual therapy and bring it with you to your first session.  This form will collect basic demographic information about you.  If any questions are unclear, please bring them up in the initial session.

5

Couples Therapy Intake Questionnaire

Please complete this form for couples therapy and bring it with you to your first session. Each partner should complete a copy of the form independently.  This form will collect basic demographic information about you, as well as ask basic questions about your history and current needs in relation to psychotherapy. If any questions are unclear, please bring them up in the initial session.

Reach Out Today

Email to Schedule an Appointment

Contact Information

Phone: (347) 815-7780
Email: todd@toddandersonphd.com

Manhattan Psychotherapy

Psychotherapy in New York's Flatiron District

Todd Anderson, PhD, LP maintains a private practice psychotherapy office located in Manhattan.  He provides individual and couples therapy to a diverse communty including gay men, those struggling with sexual behaviors, BDSM/Kink practitioners, those with religious confusion or trauma, those coping with chronic physical illness, and those with previously unsuccessful or incomplete courses of psychotherapy.

SUBSCRIBE

Get practice updates and free resources.


CONNECT WITH US

Website was designed with Mobirise