Download Forms

In order to better serve our clients, we have provided the forms necessary for a new patient. Please download, print and fill out these forms prior to visiting our offices.

1. Policies (please read!)
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2. New Patient Signature Form
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3. Hippa Agreement
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4. Hippa Signature
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5. Questionaire

These forms are in PDF format. Most computers and web browsers are compatible with this file format. If you computer is not able to view these files download Adobe Acrobat for free:




Please contact Dr. Friedman for further information or to schedule a consultation.

Dr. Dina Friedman
Licensed Clinical Psychologist
Private Practice
Reston, VA
703-859-5608
doc4mind@yahoo.com