Forms

How to Fill Out Digital Forms

* Please complete all necessary forms prior to your initial session.* Your forms will automatically be sent to Dr. Eisenberg once submitted.

Click the button underneath the appropriate age category. This will take you to a secure site where you will fill out a digital PDF form.
Enter your name and email address to authenticate, then click the “Get Started” button.
A thank you screen will pop up to confirm that your form was submitted.

Forms for Children Ages 2-12

Fill out this form if your child is 2-12 years old.

Go to the child form

Forms for Adolescents Ages 13-17

Fill out this form if you or your child is 13-18 years old.

Go to the adolescent form

Forms for Adults Ages 18+

Fill out this form if you are 19 years old or older:

Go to the adult form

Authorization to Release Information

Fill out this form if you would like Dr. Eisenberg to coordinate care with another provider (for example: your psychiatrist, primary care physician, etc.).

Go to authorization form