Licensed Clinical Social Worker

 

 

 

 

 

 

 

 



 therapy72.jpg
Life is not about waiting
for the storm to pass,
it's about dancing in the rain.
DOCUMENTS
Please download and bring these completed forms to your first appointment.
Please also bring your ID and, if you are using insurance, your insurance card.
Information, Agreement & Consent: Please complete and return the last two pages.

Intake Form: Please complete with as much detail as possible.

Notice of Privacy Practices: Please review the Notice. Complete and return only the last page.

 

THANK YOU!
Barbra Rogoff, LCSW
4307 Western Park Place, Suite 204
Durham, North Carolina 27705
(919) 201-3498 Phone
(919) 885-1014 Fax
[email protected]