New Patient Forms

 

If you are a new client, or interested in becoming one, please complete the following forms and bring them to our first therapy session. 

I prefer all clients who can to complete the following questionnaire and review and print the cancellation policy.

Adult Intake Questionnaire

Therapy Cancellation Policy

Please take a moment to familiarize yourself with our HIPAA/Psychotherapy Agreement Form, Electronic Communication Form, as well as the PA Notice Form

If you would like your care coordinated with another provider (for example, your psychiatrist or primary care physician), complete this form to authorize release of psychotherapy information. It is a good idea, which I encourage clients to complete.

Personal Choice or Keystone HealthPlan East clients, managed by Magellan, should complete this form as well. 

Carebridge EAP clients should bring this form to the first session. 

Dr milbourne's standard office hours are:

Monday 10:30am-6:30pm

Tuesday 7:30am-6:30pm

Wednesday 7:30am-6:30pm

Thursday - morning at Plush Mills Senior Living; 11:45am-6:30pm in the office

Friday 7:30am-2pm

Occasional Saturday mornings (approximately one per month)

 

CLick here to connect to the Therapy Portal where you can schedule and change appointments and add other personal information to your record.