Jason Levin, LCSW
(302) 464-0021
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A Few Quick Pieces of Paper

While I do my best to keep the paperwork to the minimum to save a few trees (and your hands!), I do need just a few pieces of paper from you (only four!) to make sure that you're getting the best service from me and so that you know your rights, my obligations, and the laws regarding privacy and confidentiality.

Please fill these out and either bring them to our first meeting or scan them and send them to jason@jasonlevinlcsw.com, whichever is easiest for you!

Confidentiality and Privacy

Just like with any health professional, including your doctor, I will keep your information in the strictest confidence.  That means password-protected and under lock and key.

This document explains your rights and the laws regarding your privacy.
Download Privacy Notice

Getting To Know You

While our work together will obviously help us get to know each other, this form just has a few questions that could help us jump start our work.  For instance, knowing your name is always a big plus, right?

There's a version for adults and a version for children.
Download for Adult
Download for Child
Jason Levin, LCSW  LLC | Call  (302) 464-0021 | Fax (302) 298-0919  120 W. Main Street, Middletown, DE 19709 |  
E-mail  Jason@JasonLevinLCSW.com