Tara Moser, LCSW

Licensed Clinical

Social Worker

#SW8379

 

3723A Del Prado Blvd.

Cape Coral, FL 33904

 

239-540-1155

 

Once you have an appointment scheduled, please click on the following forms, print them, complete them to the best of your ability, and bring them with you to your first session as to allow more time to talk and less time completing paperwork during your session.

 

Simply click on the forms below to view and launch a pdf that may be printed.

 

Client Intake

(please complete from bold line up)

 

Client Consent

 

Client Policy Statement

 

Notice of Privacy Practices

(your copy to keep, please review)

 

Receipt of Privacy Practices

 

Client Social History

 

Credit Card Authorization

 

 

You can Download a pdf our brochure here.

 

Front               

       

          Back

        

The Forms are PDF files; the Adobe Reader is required.
Click Here to Get the Free Reader.