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Jaclyn Starritt PHD PLLC

WebJaclyn Starritt, Ph.D., PLLC. starritt@tcbhcary.com. Phone: (919) 415-1793. Fax: 1-888-971-4293. 2015 Top Psychologists in Cary. Having lived in North Carolina since middle …

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Jaclyn Starritt, Ph.D., PLLC Office within Triangle Center for

Web!1 Jaclyn Starritt, Ph.D., PLLC Office within Triangle Center for Behavioral Health Developmental Questionnaire Client Information: Name: Age: _____ Date of Birth: __/ /

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Jaclyn Starritt, Ph.D., PLLC Office within Triangle Center for

Web!3 Famil /Medical/Psychiatric History Do any medical illnesses run in the family? (Example: seizures, thyroid problems) Yes No Don’t know

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New Client Intake Form for Keisha Bryan, LCSW, LCAS

WebWake Renewal Counseling, PLLC Office of Keisha Bryan, LCSW, LCAS 539 Keisler Dr. Suite 201 Cary, NC 27518 919-520-9392 (phone) New Client Intake Form for Keisha …

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Jaclyn Starritt, Ph.D., PLLC Office within Triangle Center for

Web!4 Need for oxygen Blue color Meconium Cord around the neck Jaundice/yellow color Feeding problems Maternal health Did these complications result in an extended …

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Good Faith Estimate

WebGood Faith Estimate You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost Under the law, health care providers need to give …

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Jaclyn Starritt, Ph.D., PLLC Psychological Services

Web• Child Abuse: If information is given which leads me to suspect child abuse, neglect, or death due to maltreatment, I must report such information to the county Department of …

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