BOOK AN APPOINTMENT

Fill out the forms below to request an appointment with Dr. Shapiro.

We will reach out to you after you fill out your forms.

*Note, Please be sure to scroll down and click the links below to complete the rest of the forms.

Required Intake Forms:

  1. Contact Information: https://forms.formhippo.com/TNNDSIX/DemographicInformation


  2. Informed Consent for Care: https://forms.formhippo.com/TNNDSIX/InformedConsentforCare

  3. Disclosure Consent: https://forms.formhippo.com/TNNDSIX/DisclosureConsent

  4. Consent for Telehealth: https://forms.formhippo.com/TNNDSIX/ConsentforTelehealth

  5. Emergency Contact Form: https://forms.formhippo.com/TNNDSIX/EmergencyContact

  6. Notice of Privacy Policy: https://forms.formhippo.com/TNNDSIX/NoticeofPrivacyPolicy

  7. Text/Email Consent: https://forms.formhippo.com/TNNDSIX/TextEmailConsent

  8. Child/Adolescent Consent Form: https://forms.formhippo.com/TNNDSIX/ChildAdolescentConsent

  9. Parental In-Person Waiver: https://forms.formhippo.com/TNNDSIX/ParentalInPersonWaiver

Cancellation policy:

  • If you cancel your session it must be done at least 24 hours prior to the session to receive a full refund

  • If your session is canceled by Dr. Shapiro for any reason you will receive a full refund