Sheryl R. Jacobs, Ph.D.
8 Reservoir Circle, Suite 105, Pikesville MD, 21208 | 410-580-9045 (p) | 410-580-9046 (f)

New Client Registration

  • If you are a new client, please click on the appropriate link below to access the necessary forms.
  • Completed forms should be run off and brought with you to your first appointment. At the current time, forms cannot be emailed to me due to confidentiality issues related to HIPPA legislation.
  • Please be aware that I do not participate with any insurance plans and my practice is a “fee for service” practice. Although full payment is expected at the time of the visit, I can file an electronic claim for the services provided to you if you participate in a preferred provider plan or point of service plan. You can also be provided with a monthly statement that includes all necessary information to file a claim yourself or to use with your Health Service Account or Flex Spending Account. Please see the “Fees and Payments” page of my website for additional information about insurance reimbursement.
  • If you have any previous reports or information that you feel might be helpful, please bring a copy of this information along with you as well.

Clients Under 18

Download Forms

Clients Over 18

Download Forms

All Clients

  • Please read the Therapist Patient Agreement (HIPPA) prior to coming in for your first appointment. You may print this form for your records or read it online.