Please download the appropriate forms and bring the completed forms to your first appointment.



              

















*Once submitted to the therapist, the information is considered Protected Health Information (PHI) under HIPAA. Please do not email any information as the confidentiality of electronic submissions can not be assured. 





           Email: drjessicaharrell@gmail.com
or call (248)767-5985
ADULT_BACKGROUND_FORM.pdf
ADULT_BACKGROUND_FORM.pdf
ADOLESCENT_BACKGROUND_FORM.pdf
ADOLESCENT_BACKGROUND_FORM.pdf
CONSENT_and_POLICIES_FORM.pdf
CONSENT_and_POLICIES_FORM.pdf