Forms for New Clients

Please thoroughly review and complete the four forms below prior to your first appointment. Bring completed forms with you to your initial consultation.


 Forms for New Clients of Jaclyn Alper, Licensed Professional Counselor in Center City Philadelphia


Please make sure to read thoroughly:

(1) Notice of Privacy Practices: standards for the privacy and confidentiality of your information


Please make sure to complete and bring with you to your first appointment:

(2) Office Policies & Consent Form: information about therapy and office policies (e.g., communication between sessions, payment, cancellations)

(3) New Client Form: gathers contact and biographical information and asks about any concerns or problems you may be experiencing

(4) Acknowledgement of Fees: outlines fees for sessions, as well as late cancellations and missed appointments



Any questions that you have about these forms will be addressed and answered at your consultation, but please feel free to contact me if you have any questions that you would like answered prior to your consultation appointment.