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Forms

Please complete and bring these forms with you when you come for your first visit. This will help save time in that first appointment. I look forward to meeting you.

Consent for Treatment
Identifying Information Form

Call or Email

248.677.3901
sam@samcherianphd.com

Privacy Policy

All patient or client information is to be treated as confidential, including the fact that the patient receives (or previously received) services through this office. The privacy and confidentiality of our patients are protected under the Ethics Codes of the mental health professions, state laws and regulations, and federal HIPAA Regulations. No patient information may be disclosed without the explicit informed consent of the patient.

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