Forms

FORMS will be signed electronically via the patient portal.
Informed Consent for Treatment
Teletherapy Informed Consent Form
Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy Practices
Email, Texting and Phone Policy
Social Media Policy and Protections

New Patient Registration
If you are inquiring about services, first contact Melissa Pirwani via email or phone.  Melissa Pirwani offers a short phone consultation to discuss your needs, expectations of therapy, session fee and schedule.  You will also be provided a copy of a "Good Faith Estimate" if you are uninsured or insured, but not using your insurance benefits.  Please see the "Fees" tab for more information about your right to a Good Faith Estimate or www.cms.gov/nosurprises.  If both parties decide to meet, you will be asked to complete a online registration form and a background questionnaire prior to your first appointment. 
Follow the prompts for "Haven't seen Ms. Pirwani before? Register as a new patient.