Peg Haust-Arliss, LCSW-R Certified Cognitive Therapist

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Peg Haust-Arliss, LCSW
(315) 398-1989
peg@peghaust.com



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Peg Haust-Arliss, LCSW-R
Psychotherapist in Seneca Falls
 
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First Appointment Forms

If you are a new client, please print and complete each document (where applicable) and bring them with you to the first session. This will save time during the first session. There will be a couple more to fill out in person, so please plan to arrive at the first session a few minutes early. Thank you and look forward to meeting with you!

  • Treatment Agreement
  • Treatment Agreement Regarding Minors (if applicable)
  • Financial Policy
  • Privacy of Information Policy
  • First Appointment Information Form
  • Consent to Release Confidential Information (if applicable)

Treatment Agreement  Please print, read, sign and bring to first session if you are an adult.
Treatment Agreement Regarding Minors  Please print, read, sign and bring to first session for minors only.
Financial Policy  Please print, read, sign and bring to first session
Privacy of Information Policy  Please print, read, sign and bring to first session
   
Consent to Release Confidential Information Please print, sign and bring to first session. This is for any PCP or doctor that prescribes psychotropics to you, any previous or collateral therapist I would have to consult with, or anyone that you would like me to have contact with.
First Appointment Information Form Please print, complete and bring to first session

Note: To download Adobe Acrobat Reader for free, click here.

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