Dr. Jeff Larson, Ph.D.

 Please print and fill out Form 1,  Form  2 , & Form 3  below to bring to your first meeting with Dr. Larson.

1. Form 1:  Client Data Sheet & Disclosure Statement   (2 pages)
2. Form 2:  Consumer Rights & Consent to Treatment (2 pages)
3. Form 3:  Financial Agreement (if applicable, please bring insurance information; 2 pages)

     4.  Authorization for Use and Disclosure (1 page)