New Patient Forms

If you are a new client, or interested in becoming one, please complete the following forms and bring them to our first therapy session.

• Adult Psychotherapy Intake Form
• Older Adult Intake
• Child Intake Form

I prefer all clients who can to complete the following questionnaire and review and print the cancellation policy.

Adult Intake Questionnaire

Telehealth Informed Consent – please familiarize yourself and sign prior to using doxy.me

Therapy Cancellation Policy

Please take a moment to familiarize yourself with our HIPAA/Psychotherapy Agreement Form, Electronic Communication Form, as well as the PA Notice Form.

If you are using insurance please email pictures of BOTH SIDES of your insurance card to vatsala @drmilbourne.com or greg@drmilbourne.com. Thank you.

If you would like your care coordinated with another provider (for example, your psychiatrist or primary care physician), complete this form to authorize release of psychotherapy information or this release form. It is a good idea, which I encourage clients to complete.

Personal Choice or Keystone HealthPlan East clients, managed by Magellan, should complete this form as well.

Carebridge EAP clients should bring this form to the first session.

EMDR workbook for preparation to work on anxiety, depression and trauma.

Teletherapy Office Hours

Monday 10:30am-6:30pm

Tuesday 7:30am-6:30pm

Wednesday 7:30am-6:30pm

Thursday – 7:30am-5pm

Friday 7:30am-2pm

STATYESE

Click here to connect to the Therapy Portal where you can schedule and change appointments and add other personal information to your record.

NPI: 1598841314