Forms

Posted on: January 12, 2022

Please fill out the Patient Registration Form.
Either:

1) Fill out form online before your first visit: Patient Registration Form

OR

2) Download Patient Registration Form PDF, print, complete and bring it to your first visit.

---

Please complete the Medicare Private Contract only if you have Medicare insurance, acknowledging that you understand and will not bill Medicare for payment of Dr. Watkins’ fees. Dr. Watkins is not a Medicare provider.
If you are eligible for Medicare, either:

1) Fill out the form online before your first visit, Medicare Private Contract

OR

2) Download the Medicare Private Contract PDF, print, complete and bring it to your first visit

---

The Consent To Videotape is only for psychotherapy patients. Dr. Watkins practices a specific form of psychotherapy called Intensive Short-Term Dynamic Psychotherapy, or ISTDP.  Sessions may be videotaped and reviewed by Dr. Watkins to optimize your care. If you are seeking ISTDP please sign the consent to videotape form. If you have questions about videotaping, Dr. Watkins will be happy to discuss this with you at your first visit.

If you are seeking ISTDP, either:

1) Fill out the form online before your first visit: Consent To Videotape

OR

2) Download the Consent To Videotape PDF, print, complete and bring it to your first visit.

---

Download PDF: Preparation for Internet Therapy Video Sessions

Posted in: