Download New Client Forms here:
PersonalHealthInformation-Florida
GOALS-AND-OUTCOMES-QUESTIONNAIRE
Fees and Required Forms
(Please only read the section below that pertains to where I am residing at the time of our scheduled appointments)
Florida Fees
Initial consultations 60-75 minutes: $200
All follow-up sessions are available to each patient as 60-minute, 45-minute, 30-minute or 15-minute appointments:
- 60-minute sessions: $200
- 45-minute sessions: $135
- 25-30-minute sessions: $100
- 15-minute sessions: $60
Fees are payable by check only. Please make the check payable to Steven M. Rosman.
To get you started working with me via SKYPE or phone, I want to offer you one of two packages:
- 45-minute sessions: a package of three, payable in advance, for $270. Thereafter, 45-minute sessions will all be the usual $135 per consultation.
- 30-minute sessions: a package of three, payable in advance, for $210. Thereafter, 30-minute sessions will all be the usual $100 per consultation.
All appointments are via phone or SKYPE (www.skype.com). For those unfamiliar with Skype, it is a free service (no charge) whereby you use your computer and the camera already installed or one that you can purchase inexpensively. We can speak with clear visual and audio communication.
*PLEASE NOTE: I REQUIRE ANYONE WHO CONSENTS TO WORK WITH ME TO READ THE SECTION ENTITLED “IN FLORIDA” ON THE HOME PAGE TO FULLY UNDERSTAND WHAT DEFINES THE NATURE OF OUR WORK TOGETHER. ALSO, ALL REQUIRED FORMS MUST REACH ME BY MAIL OR FAX PRIOR TO THE APPOINTMENT.
New York Fees
- First, be sure to print and complete the forms that are necessary for our first consultation. Those forms are listed above. Please complete only those forms that are necessary for that visit, and be sure to fax them or mail them or email them to me at least one week before our appointment. My new fax number is not yet determined. To reach me by email please contact me.
- Please be sure to fax, mail, or email to me any of the medical records, blood tests, and such that I request below. I would like to receive them at least one week before our appointment so that I can prepare and provide you with the best care possible.
Required Forms
(I ask you to fax, mail, or email them to me at least one week before our first appointment. This enables me to prepare to provide you with the best care possible).
Please print out the following forms, as directed below, so that we can devote all of our time to gathering and reviewing all of the information necessary to determine what tests and treatment plan you may need.
Consent Form – Dr. Steven Rosman
Healthcare Provider Waiver
HIPAA Form
Personal Health Information
However, if you are making appointments with me for psychotherapy, hypnotherapy, biofeedback or for Rapid Transformation (Rosman Success Techniques™), you do not need to complete the Personal Health Information form. Instead, please complete the following:
- Biofeedback-Counseling Intake Form or if the patient is your child, the Biofeedback-Counseling Intake Form for Minors
- Hypnotherapy/Rapid Transformation/Energy Psychology Worksheet (to be completed by all patients)
Finally, I request that you send the following material to me at least one week prior to our first appointment.
- An outline of your personal medical history listing all hospitalizations, illnesses, medical conditions, and related issues.
- The same for your family’s history. Please provide this information for your father, mother, paternal and maternal grandparents.
- All blood tests, MRI reports, CT scan reports, X-Ray reports, surgical reports, and any other medical tests that relate to the reason(s) you are coming to see me.
- All blood tests taken by any of your physicians over the past year.
- Please make sure that any paperwork you give me I can keep. If you need to make copies, please do so.
