Paperwork
Before meeting me, please review and complete the appropriate forms below. You can email your forms to DanielMZimet@gmail.com with the understanding that email is not a confidential form of communication, mail them, or bring them to your appointment.
forms for
completion
Please complete the appropriate forms and provide them to me by email, mail, or in-person. All clients need to complete the consent form and appropriate intake form.
Forms
for review
These forms are for review only.
Consent form signature page. For the full text, see the Consent Form in the Review Only section.
Adult Intake Form. For individual clients over the age of eighteen
Minor/Child Intake Form. To be completed by a parent and the minor/child
Athlete Intake Form. Can be completed by the athlete. parent, or together
Couples Intake Form. To be completed by both members of the relationship
Consent
Form: Full text for review only
HIPAA Disclosure
Outpatient disclosure trifold
Contact
Daniel M Zimet, PhD CMPC
Zimet Wellness LLC
9520 Berger Road, Suite #203
Columbia, MD 21046
410-300-7462