Madeleine E. Bertin, LCSW
  • Home
  • About Maddie Experience
  • Eating Disorders PTSD, Complex PTSD, and Dissociative Disorders
  • Policies & Payment Practices
  • New Client Forms
  • Contact

Madeleine E. Bertin, LCSW

  • Home/
  • About/
    • About Maddie
    • Experience
  • Areas of Specialization/
    • Eating Disorders
    • PTSD, Complex PTSD, and Dissociative Disorders
  • Policies & Payment Practices/
  • New Client Forms/
  • Contact/
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Madeleine E. Bertin, LCSW

Specializing in eating disorders and trauma

“The best way out is always through.” -Robert Frost

Madeleine E. Bertin, LCSW

  • Home/
  • About/
    • About Maddie
    • Experience
  • Areas of Specialization/
    • Eating Disorders
    • PTSD, Complex PTSD, and Dissociative Disorders
  • Policies & Payment Practices/
  • New Client Forms/
  • Contact/
 

New Client Forms

 

* Please print and complete the following new client forms before we meet and bring them to our first session. 

1. Authorization for Release of Information (ROI)

2. Confidentiality Statement/Consent to Treatment

3. Financial Agreement

4. Medicare Opt-Out

5. Notice of Privacy Practices

6. Policies and Procedures

7. Psychosocial Assessment

8. Registration Form

9. Informed Consent for Tele-therapy




  • Home/
  • About/
    • About Maddie
    • Experience
  • Areas of Specialization/
    • Eating Disorders
    • PTSD, Complex PTSD, and Dissociative Disorders
  • Policies & Payment Practices/
  • New Client Forms/
  • Contact/

Madeleine E. Bertin, LCSW

Madeleine E. Bertin, LCSW is a therapist in private practice in Fairfax, VA. I provide psychotherapy for individuals, couples, families, and groups with specialties treating eating disorders, trauma, and the co-morbid issues of depression, anxiety, interpersonal issues, and self-harm behaviors.

 

Madeleine E. Bertin, LCSW
44050 Ashburn Shopping Plaza, Suite 195, Box 183
Ashburn, VA 20147
(206) 819-8042
madeleine.bertin@hushmail.com