Helpful Forms

During this time of the Covid-19 pandemic and you are a new client, we would like you to please print and fill out the appropriate forms that are in PDF format from the selection below. Select Coaching forms for Rosanna Zavarella or for Therapy select the appropriate form for either Rosanna Zavarella PhD or Roger N Hess PhD. Email or fax the filled out forms before your scheduled telehealth (phone or video) appointment. Thank you.

Email forms for:

Rosanna Zavarella, PhD, BCC to [email protected]

Roger N Hess, PhD to [email protected]

Fax forms: 216-831-1269

ROSANNA ZAVARELLA, PhD, BCC COACHING CLIENTS:

Coaching Client Intake Form

Coaching Goal Setting Worksheet

Coaching New Client Questionnaire


ROSANNA ZAVARELLA, PhD, BCC THERAPY CLIENTS FORMS:

Therapy Client Intake Form Page 1

Therapy Client Intake Form Page 2

Therapy Client Intake Form Page 3

Therapy Client Intake Form Page 4

Email or fax a copy of your insurance card (front and back)

ROGER N HESS, PhD THERAPY CLIENTS FORMS:

Therapy Client Intake Form Page 1

Therapy Client Intake Form Page 2

Therapy Client Intake Form Page 3

Therapy Client Intake Form Page 4

Email or fax a copy of your insurance card (front and back)

N ote: To download Adobe Acrobat Reader for free, click here .

Helpful Forms

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