DR. NETTA SHAKED

SOUTH BEACH PSYCHOLOGIST

Forms

DR. NETTA SHAKED

SOUTH BEACH PSYCHOLOGIST

So as to save to save time during your first appointment, please download and complete the appropriate form below. 

You may complete this form on your computer and sign it electronically, or just print and complete the old fashioned way. 

Please email/fax this form to Dr. Shaked at least one day before your appointment.

The forms are password protected. Please check the email for the password. 

ADULT THERAPY E-FORMS

Please complete if you're an adult therapy patient, and/or a member of couples therapy.

ADULT THERAPY E-FORMS

Please complete if you're an adult undergoing testing or evaluation, but not therapy. 

CHILD THERAPY E-FORMS

For anyone under the age of 18, and must be filled out by a parent

For anyone under the age of 18, and must be filled out by a parent

To release any information to any third parties (including schools, other professionals, or family members), I must have this form completed and signed. 

SOUTH BEACH PSYCHOLOGIST ®  

FREE PARKING

ONLINE SESSIONS

Psychologist for Miami Beach, Brickell, Biscayne, Aventura, Surfside, Bay Harbor, Bal 

Harbour, Hollywood

Florida and New York 

Best Therapist Miami Beach 33139 | Therapist 33140, 33141, 33129, 33154, 33160, 33179, 33180, 33181

(T) 786.942.9425 (E) [email protected]

SOUTH BEACH PSYCHOLOGIST®  

Copyright © Dr. Netta Shaked, PA. All Rights Reserved.

South Beach Psychology Office: 1000 5th Street, Suite 215, Miami Beach, FL 33139