Client Intake Form

To expedite your experience, please complete our Client Intake Form on your computer and email to surajshahcmt@gmail.com. Alternatively, you may print, fill out, and bring the form before your first appointment.

Intake Form

Prenatal Release Form

If you are currently pregnant or are planning to be, please review and sign this form. Email this form along with the client intake to surajshahcmt@gmail.com prior to your appointment. Should further explanation, doctor’s approval, or direct contraindication be necessary; your therapist will notify you.

Prenatal Form

Minor Release Form

Parents or guardians who want their child to receive treatment, please review and sign this form. Email this form along with the client intake to surajshahcmt@gmail.com prior to your appointment. Notify your therapist of any existing health conditions.

Minor Release Form

Forms

Client Intake Form

Prenatal Release Form

Minor Release Form