Client Forms

After setting a meeting with Dr. Stanley, please download, complete these forms, and email them to jeannelstanley@gmail.com prior to your first session

Structure Agreement Form

HIPAA Privacy Notice

Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act

Client Payment Process

Release of Information Form (Note: Only needs to be completed and returned if relevant)

Additional Resources for Ongoing Clients

ADHD Screener

ASRS Form Instructions

ASRS Symptom Checklist

Click for More Resources