This is the secure (SSL) password protected online non-clinical intake form for the office of Robert Odell, LICSW. It will take about 15 mins. to complete.
After the form is sent, I will arrange a phone conversation with you, usually within your indicated times. I will answer your questions, and secure a first appointment time.
A valid credit, debit or checking account must be provided to secure the appointment . My policy is identical to hotel reservations, as a guarantee in the event you do not appear for your appointment. E-mail reminders are issued twice within 5 days of your appointment.
DIGITAL SIGNATURES: The intake form requires digital signatures. They might not resemble your normal handwritten signature. They serve as legal confirmations that you have understood key parts of the form. You can have a hard copy to discuss any terms during our first appointment.
These are the forms to be completed:
Please be sure to read or review all informational pages.
Robert Odell, LICSW
If insurance is being used, and you are not the policyholder, please enter policyholder information: