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Shana Millstein, Ph.D.
Counseling and Psychotherapy for Adults and Couples
Shana Millstein, Ph.D.
(415) 820-1611
shana@drmillstein.com

3628 Sacramento Street, Suite 3
San Francisco, CA 94118

 
Forms

If you're a first-time client, please review the files below before your first session. The Treatment Consent & Office Policies form and the Health History form should be completed by you and brought to the first session.  If you are coming for couples therapy, please also complete the Relationship Questionnaire.  This will give us more time to talk in our session, and will allow you to formulate ahead of time any questions you may have about the material. The Notice of Privacy Practices and Patient Bill of Rights forms contain important information that you should review before beginning treatment.

The documents are in Adobe Acrobat PDF format. If you do not have the Adobe Reader it is available free from Adobe. Your browser may already have the capacity to read these files. Please let me know if you are unable to download or print these forms and we can arrange for them to be filled out at the office prior to our first appointment.


Notice of Privacy Practices  
Health History and Client Information  
Office Policies and Consent to Treatment  
Client Bill of Rights  
Relationship Questionaire  

Note: To download Adobe Acrobat Reader for free, click here.