651-357-3216
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Forms

Here are the standard download forms for Dr. Mary Freitag. Please print the forms, fill them out and bring them to your appointment.


Adult Intake Form, editable PDF 

This is an editable PDF form. You will need Adobe free Acrobat Reader, get it here.

Instructions:

  1. Download the form to your desktop, right click on the link and select 'Save Target As" or "Save Link As" to save it to your desktop. On a Mac, the first click opens the PDF in a browser — just click an icon on top right in that screen to open in Preview, then fill it out
  2. Type in your info
  3. Be sure to save the file as you go
  4. You can also choose to print the blank form and fill it out by hand.  

Download the Adult Intake Form PDF


Remaining forms to be completed for your therapy session.

Telehealth Consent Form

New Patient Consent Form

New Patient Intake Form

New Patient Release Form

Policy Statement

HIPAA Statement

What to ask your insurance carrier - How to find out what your insurance plan will cover and what may be out of pocket costs to me

Please call Dr. Freitag at 651-357-3216 if you have any questions.

©2019 Integrative Psychological Services P.A. | Integrating Body, Mind, Spirit, and Community | A Whole Health Approach
Mary G. Freitag, Psy. D., L.P. | Licensed Clinical Psychologist | 651-357-3216 | This email address is being protected from spambots. You need JavaScript enabled to view it.      10480 Perkins Ave North | Stillwater, MN 55082  
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