Peter J. Paterno, MSW, LCSW

You may click on these links to obtain some of the forms prior to seeing me.  Completing these in advance saves time before your appointment.

Informed Consent

Client Demographic Form (Adult - 18 years+)

Client Demographic Form (Child or Adolescent)

Insurance Release (In-network plans only)

Primary Care Authorization

Credit Card Payment Form

Client Satisfaction Survey

Release Form

All clients must complete the Informed Consent form and one of the two Client Demographic Forms depending on the age of the client..

The Insurance Release Form is for clients for whom I am in their insurance plan as an in-network provider. 

The Primary Care Authorization form allows me to speak with your primary care doctor.  You do not have to give consent.  However, if you are receiving any medications for mental health reasons from this doctor, I recommend allowing us to freely communicate.

The Credit Card Payment Form is only necessary to complete if you plan to pay your fees with a credit card.

The Client Satisfaction Survey can be completed at any time during your work with me.  Please complete it and mail to the address on the form.  You may keep it anonymous.

The Release Form can be completed if you would like me to have contact with a former provider, school or anyone else concerning your past or current treatment.

"Perseverance is not a long race; it is many short races one after another."

--Walter Elliott