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.

Forms*:

*Click to open the form. The forms are in a pdf file format and can be downloaded and/or printed.

Stacey Uebersax, Psy.D.

4800 Roland Avenue
Suite 300
Baltimore, Maryland 21210

(410) 554-0099 (Office)
(443) 622-6876 (Cell)

StaceyUebersaxPsyD@gmail.com

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Copyright © 2019 Stacey Uebersax