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415.971.9722

327 N. San Mateo Dr, #7, San Mateo CA 94401

©2017 BY DR. STEPHANIE J. WONG, PHD, LICENSED CLINICAL PSYCHOLOGIST. PROUDLY CREATED WITH WIX.COM

Forms

Consent Form

Dr. Wong will email you this form via DocuSign.  Alternatives to DocuSign would be to print and fill out the form prior to the initial session, and bring it to the first session. You may also scan and email to stephaniewong2@gmail.com.  Please be advised that email is not encrypted, but this is an alternative to printing the documents and bringing the paperwork to the first session. 

Notice of Privacy Practices

After reviewing this document, please retain for your records. 

Intake Form

Dr. Wong will email you this form via DocuSign.  Alternatives to DocuSign would be to print and fill out the form prior to the initial session, and bring it to the first session. You may also scan and email to stephaniewong2@gmail.com.  Please be advised that email is not encrypted, but this is an alternative to printing the documents and bringing the paperwork to the first session. 

If you have the Lyra Health benefit, please fill out the following e-form.

Screening Tool

Please fill out as much information as you feel comfortable with sharing.  Dr. Wong will email you this form via DocuSign.  Alternatives to DocuSign would be to print and fill out the form prior to the initial session, and bring it to the first session. You may also scan and email to stephaniewong2@gmail.com.  Please be advised that email is not encrypted, but this is an alternative to printing the documents and bringing the paperwork to the first session. 

Release of Information

This form is optional. It only needs to be completed and submitted to Dr. Wong if you would like to provide her with additional information from specified individuals (e.g., past providers), or you would like her to share information with specified individuals.   Dr. Wong will email you this form via DocuSign accordingly.  Alternatives to DocuSign would be to print and fill out the form, and bring it to session. You may also scan and email to stephaniewong2@gmail.com.  Please be advised that email is not encrypted, but this is an alternative to printing the documents and bringing the paperwork to the first session.