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

Adult History and Background Form

Child/Adolescent History and Background Form

Consent to Treatment

Office Policies
              
*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