Marni L. Jacob, Ph.D., ABPP - Licensed Psychologist
  • Welcome
  • Bio
  • Specialties
    • Obsessive-Compulsive Disorder
    • Anxiety Disorders & Phobias >
      • Generalized Anxiety Disorder
      • Social Anxiety
      • Separation Anxiety
      • Agoraphobia
      • Panic Disorder
      • Selective Mutism
      • Specific Phobias
    • Tic Disorders
    • Trichotillomania
    • Body Dysmorphic Disorder
    • Hoarding
    • Skin-picking
    • Behavior Problems
    • Depression
  • Services
  • Publications
  • Links
  • Forms
  • Contact
  • FAQs

Forms

*Dr. Jacob has a secure online portal where new patient forms can be completed electronically. You may provide Dr. Jacob with your email address if you would like to receive the link to complete the forms electronically. If you have scheduled a new patient appointment and have not yet received this portal link, please contact Dr. Jacob. Alternatively, you may print the new patient forms from below, complete them by hand, and bring them to your initial intake appointment.
​
​The following forms are to be completed prior to the first appointment. Other forms will be completed as needed.
- New Patient Form (Either Child or Adult)
- Informed Consent & Outpatient Services Contract
​- Acknowledgement of Notice of Privacy Practices
New Child Patient Form
New Adult Patient Form
Informed Consent & Outpatient Services Contract
Notice of Privacy Practices (Read Only)
Acknowledgement of Notice of Privacy Practices
Release of Information
Consent for Email Communication
Consent for Skype
Providing Evidence-Based Treatment for Obsessive-Compulsive Disorder (OCD), Tourette's Disorder/Tics, Trichotillomania, Body Dysmorphic Disorder (BDD), Hoarding, Skin Picking/Excoriation Disorder, Anxiety Disorders, and Phobias. Boca Raton office is easily accessible from Palm Beach County & South Florida (Jupiter, West Palm Beach, Lakeworth, Boynton Beach, Delray Beach, Boca Raton, Lighthouse Point, Deerfield Beach, Pompano Beach, Ft. Lauderdale, and Miami).


​Copyright © 2015-2019 Marni L. Jacob, Ph.D., LLC
1200 N. Federal Highway, Suite 200, Boca Raton, FL 33432