If you are bringing in your child for psychological or psychoeducational assessment and/or therapy, please download and complete the following forms and bring them to our first appointment 15 minutes early please.
- HIPAA Notice of Privacy Practices
- About me for patients
- Basic Rights in Psychotherapy
- Informed Consent
- My Child's Therapy Contract with Dr. Cibelli
- RADDLED
- Reiss-Davis Family & Developmental
- Self Test for Irlen Syndrome
- Face Sheet
- If you are a new patient or adult student seeking assessment and/or therapy, please complete the following forms and bring them to our first appointment 15 minutes early please.
- Client Psychotherapy Intake Form
- HIPAA Notice of Privacy Practices
- About me for patients
- Basic Rights in Psychotherapy
- Informed Consent
- RADDLED
- Self Test for Irlen Syndrome
- Face Sheet
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
Note: To download Adobe Acrobat Reader for free, Click here.