Forms

The following forms may be printed, filled out and brought to your appointment.

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• Cancellation and No-Show Policy
• Confidential Intake Form for Adults
• Notice of Privacy Practices
• Psychologist-Patient Services Agreement​
• Patient Telehealth Informed Consent

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​© John Lynch, Ph.D

Summit Emotional Health 
8921 Three Chopt Road
Richmond, Virginia 23229
​804-562-6557
​[email protected]

​In case of an emergency, please dial 911.