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Stacey Uebersax, Psy.D.
Licensed Psychologist
Maryland License 03962
New York License 025916
PsyPact Authorization 11559
Forms
Please let me know if you would prefer to arrive 15 minutes early to your appointment to complete paperwork or if you would prefer to complete paperwork at home. If you complete at home, it is only necessary to print and bring the New Client Data Form and the Receipt and Acknowledgement of Privacy Practice and Informed Consent.
Please read the Privacy Practice and Therapy Informed Consent carefully and bring any questions you have to our first session.
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