Forms

UPDATE from Dr. Gombatz:   Explanations of Forms

There are two kinds of forms: a) For those seeking treatment -  The form is Titled -  “Severn Psychological & Educational Services  (For Patients Seeking Treatment)”  or b) Individuals involved in the legal system (forensic) and having  Court Ordered evaluations.  The form is  Titled - “Severn Psychological & Educational Services (For Court-Ordered and Independent Evaluations)”

For those seeking treatment or an evaluation for treatment purposes:  

For your convenience, there are PDF formats of Patient Intake/Informed Consent forms named  Treatment-PDF,   A PDF Version for those who wish to complete the Patient form on line, and email to the office.  

If you complete the PDF form email it to:  mgombatz@gmail.com   For the other two versions bring the completed form with you.   

If you chose not to complete the forms in advance, please come 20 minutes prior to your appointment.  You may complete them at the office. 

For those Court  Ordered for an evaluation and are NOT seeking treatment:  

For your convenience, there are PDF formats of Patient Intake/Informed Consent  forms named:  Forensic-PDF:   A PDF Version for those who to complete the Patient form online and email to the office.   

NOTE: To help with Creating a Digital Signature for PDF (Adobe DC), you can watch this YouTube Video  

Before you can type information into the form, you will have to download the file. To download and print a PDF file, you will need to have the Adobe Acrobat Reader software installed. You can download the latest version of Adobe Acrobat Reader FREE from Adobe Reader download page on Adobe's Web site.