Tanya Ruckstuhl Valenti, LICSW

Forms

Provided here for your convenience...

are the intake forms you are required to complete prior to your initial appointment. Click on the links below to download the forms.


Your computer must have the Adobe Acrobat Reader to download the forms. If not you can download a free version here.


HIPPA Notice (PDF)

Release of Information (PDF)

Clinician Disclosure Statement


Susie Wind Disclosure Form...

Click on the links below to download the form.


Your computer must have the Adobe Acrobat Reader to download the form. If not you can download a free version here.


Clinician Disclosure Statement