CENTER FOR ANXIETY DISORDERS AND PHOBIAS

 

Registration Forms

Forms for Diane E. Sholomskas, Ph.D.

Please download all of the following registration forms and policy documents for Diane Sholomskas, Ph.D. Please read and complete these registration forms and bring them with you to your appointment. If you have any questions, please call us at 203 776-2077 ext. 1.

  1. Billing Information and Payment Policy
  2. Acknowledgement of Receipt of Notice of Privacy Practices
  3. Notice of Privacy Practices
  4. Patient Information
  5. Medical History Questionnaire

Forms for Dr. Alan J. Sholomskas, M.D.

Please download all of the following registration forms and policy documents for Dr. Alan Sholomskas. Please read and complete these registration forms and bring them with you to your appointment. If you have any questions, please call us at 203 776-2077 ext. 1.

  1. Billing Information and Payment Policy
  2. Acknowledgement of Receipt of Notice of Privacy Practices
  3. Notice of Privacy Practices
  4. Patient Information
  5. Medical History Questionnaire