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Patient Intake Forms

Please download, complete and return
the documents below

Online Application

This and all other information relating to your association with Online Therapy and Counseling
Until Midnight/Dr. John Silver is regarded as strictly confidential and will not be shared with anyone without your signed consent.

Download

Telemedicine Form

Telemedicine informed consent form including and not limited to online therapy, chat, webcam, email, phone consultation.

Download

Instructions Online Office & Paypal

Instructions for PayPal and Our HIPAA Compliant Online Office at
Doxy.Me/DrJohnSilver

Download

Confidentiality, Payment
and Electronic Communication

Agreement regarding confidentiality, payments and electronic communications outside of the office

Download

Online Client Contract

General Client Contract, Confidentiality and Fees

Download