Dr. Eileen Callahan, Ph.D.: Online Forms

To help expedite your first visit, we offer downloadable PDF versions of our new patient intake forms which may be printed and filled out in the convenience and privacy of your home. Please take a few moments to download and complete the forms below.

  • If you don't have Adobe Acrobat Reader installed, please click here to download and install for free.
  • Download and print the required forms below.
  • You may fax these to our office or bring them with you on your first visit.
  • In order to protect your privacy, please do NOT email these forms to our office.

New Patient Intake Form

This form provides us with your basic contact, insurance and billing information.

Download and Print Form

New Patient Intake Form Additional Information - Minors / Children / Adolescents

This form provides us detailed information required for treatment of children.

Download and Print Form

HIPAA / Notice of Privacy Practices Form

Protecting patient privacy and safety is extremely important. This document describes how medical information about you may be used and disclosed and how you can get access to this information.

Download and Print Form

Informed Consent

This document describes the general process therapy, general policies and procedures, and allows you to make an informed decision regarding treatment.

Download and Print Form


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This site cannot be used to initiate emergency contact. We cannot respond on-line to crisis situations. If you are in crisis, please call the National Suicide Prevention Lifeline 1-800-273-8255 (TALK)

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Mon 9:00 am 7:00pm
Tues 9:00 am 7:00pm
Wed 9:00 am 7:00pm
Thurs 9:00 am 7:00pm
Fri 9:00 am 7:00pm
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Suicide Prevention Lifeline: 1-800-273-8255