Intake / Consent Forms

The very first form that will need to be completed is your intake form. 

Intake form


After completing your intake form, there are consent forms (found below) that will need to be downloaded and signed as well. To be more eco-friendly, it's encouraged to sign them digitally using Adobe Acrobat. Below you will find links for how to download this free software and on how to use the "fill and sign" feature.


After downloading and signing the required forms, you will need to upload them here:

Consent Forms Upload


If you have any questions or concerns, don't hesitate to contact Maevon!


HOW TO FILL OUT AND SIGN A PDF FORM

DOWNLOAD ADOBE ACROBAT

Individual Services - Therapeutic Agreement & Informed Consent

Required for all individual music psychotherapy and gender affirming voicework services. 


Please note that there are a few places on this form that require initialing and fill-in-the-blank.

DOWNLOAD FORM

Transgender, Nonbinary, and Gender Expansive Group - Therapeutic Agreement & Informed Consent

Required for the Transgender, Nonbinary, and Gender Expansive group


Please note that there are a few places on this form that require initialing and fill-in-the-blank.

DOWNLOAD FORM

HIPAA: Notice of Privacy Practices

Required for all services

DOWNLOAD FORM

Consent to the Treatment of Minors

Required for all identified clients who are under the age of 18

DOWNLOAD FORM

Authorization to Release / Exchange Information (optional)

Required only if you are wanting Maevon to coordinate care with a third party (e.g., family member, partner, primary cary physician, psychiatrist, etc.). If completed, a separate form will need to be completed for each third party.

DOWNLOAD FORM

based in Pittsburgh, PA

Available for appointments

Monday: 11am - 8pm EST

Tuesday: 11am - 8pm EST

Wednesday: closed

Thursday: 11am - 8pm EST

Friday: 11am - 8pm EST

Saturday: closed

Sunday: closed