Forms For Starting Therapy With Me

Here are forms you will need to start therapy with me. Please print them, fill them out, and sign them.  The easiest way to get the completed forms to me is electronically.  To do so, please scan them to your computer and then attach them to your response to an encrypted email from me (see next paragraph). Alternately, you can send hard copies by snail mail to my mailing address: Gerald Greenfield, Ph.D., PO Box 259595, Madison, WI 53725-9595. 

Secure email communication can be initiated by completing the contact form at the bottom of this or other pages of my website. Once I get your submitted form, I will email you back with a secure email, and then you can attach the forms to your response to that email, and they will be encrypted. If this is confusing or you have any questions, don't hesitate to leave me a voicemail message at  608-271-8799, and I'll walk you through the process. 

Treatment and Financial Contract

Demographics Form

Informed Consent

Notice of Privacy Practices

Receipt of Notice of Privacy Practices

Consent for Email

Consent for Remote Electronic Sessions

Clients starting couples or marital therapy will also need to complete the following form:

Confidentiality Agreement - Marital /Relationship Therapy