If you are experiencing a medical or psychiatric emergency, call 911 or go to your nearest emergency room.
Before Your Visit

Patient Forms

To help your first appointment run smoothly, please download, complete, and bring the relevant forms below. If you have any trouble opening a document, contact our office and we’ll send it to you directly.

Not sure which forms you need? Call 414.255.0626 or email susan@drbloompsych.com and our office will help you get set up before your appointment.
PDF

Release of Records

Authorization to release or request confidential health records.

Download
PDF

Informed Consent for Treatment with Medications

Consent form outlining the risks, benefits, and expectations of medication management.

Download
PDF

Notice of Privacy Practices

An overview of how your health information is used, shared, and protected under HIPAA.

Download
PDF

Release of Information to Insurance

Authorization allowing our office to share necessary information with your insurance provider.

Download
PDF

New Client Form

Intake paperwork for new patients to complete before their first appointment.

Download
PDF

Insurance Verification Form

Provide your insurance details so our office can verify your benefits ahead of your visit.

Download