Psychologically Speaking with Dr. Jack Singer, LLC
New Patient Information Sheets
Adults [PDF]
Informed Consent for Telephone/Skype Therapy [PDF]
Minors [PDF]
Informed Consent for Telephone/Skype Therapy [PDF]
Instructions:
- Print patient form (2 pages)
- Fill in information
- Bring to first appointment with Dr. Jack Singer OR
- Fax to 949-481-5057 if your appointment is a phone consultation
Dr. Jack, Once again, thank you for helping me not only see my dreams but make them come true. I had a level of confidence I did not believe was possible and what you taught me was a true gift. Thank You for working with me and helping me to achieve my true potential and I will definitely be seeing you in the future! ~ Julia “The Jewel” Budd, Gibson Kickboxing & Pankration