Laura Struhl, Ph.D.
Licensed Psychologist #PSY 12173

Please print this form, complete all blanks in ink, and bring it with you to our first meeting. Note: this process was intentionally designed to avoid sending your private information through the Internet, and will protect you from breaches of confidentiality online.

This form is saved as a PDF file. If you need a program to read this file, you might consider downloading a PDF reader. If you want a free PDR reader, go to the Adobe website.


New Client Information Form – PDF