Required Forms

Thanks for visiting our page!

Please scroll down for our forms!

To learn more about our therapy practice and services, please complete our Contact Form, so we can discuss your needs.

You’ve had your free phone consultation and/or your initial email conversation with us? Congratulations! Welcome to the North Shore Family Services family. You are ready to get started.

You’ve been assigned a therapist who fits your needs and schedule? Great! Use your login and password information to click your clinician’s name below and  complete your HIPAA compliant online registration.

Our Electronic Health Records system is working on having all paper forms included on these links, but for now, please also complete the paper forms listed below.

 

“Behind every good therapist, there is paperwork.”  (we have no idea who said this)

 

For online forms, click your therapist’s name below:

Lisa Brickert, MSW, LCSW

Lisa Marie Carlson, MSW, LCSW

Elyse Dombrowski, MA, LMFT

Jean Hausmann, MSW, LCSW

Haley Jossel, MA, LMFT

Dori Mages, MSW, LCSW

Emily Ptacek Goldman, MSW, LCSW

Kathryn “Katy” Robb, MSW, LCSW

Sarah Rudek, MA, LPC

Mehnaz Siddiqui, MA, LCPC

Kendra A. Vargas, MA, LPC

Julia Woodson, MSW, LSW

Please complete these paper forms too:

Intake Forms-Checklist

Consent to Release Information

Developmental History/Current Strengths & Needs- Children and Teens

Developmental History and Current Strengths & Needs- Over 18

Practice Information

HIPAA Privacy Notice