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PHILADELPHIA: 2401 Pennsylvania Ave, Unit 1C52, Philadelphia, PA 19130       BALA: 2 Bala Plaza, Suite 13, Bala Cynwyd, PA 19004

Jeremy Frank & Associates

Jeremy Frank & Associates

Therapy for Addiction & Mental Health

  • START HERE
  • About
    • Mission and Values
    • Testimonials
  • Meet the Therapists
    • Jeremy Frank, PhD, CADC
    • Carla Runnels, LPC, CAADC, MA
    • Nick Nehéz, MFA, LSW
    • Jordan Lief, PsyD, CSAT
    • Alexander Ott, MA, LMFT
    • Yona Davidson, PhD
    • Jake Brennan, MA, LPC
    • Kent Matthies, MFT, MDiv
    • Molly Schenker, LSW
  • Services
    • Individual Therapy
    • Family Counseling
    • Couples Therapy
    • Evaluation
      • DUI DWI Legal Alcohol or Drug Evaluation
    • Teletherapy – Online Counseling
    • Groups
  • How We Work
    • Evidence Based, Empirical & Best Practices Models
    • Individualized and Personalized Therapy
    • Harm Reduction
    • Twelve Step (12 Step) Approaches
    • SMART Recovery
    • Abstinence Based Approaches
    • The ASCENT Approach
  • Specialties
    • Drug and Alcohol Addiction
    • Gambling Addiction
    • Gaming Addiction
    • Sex & Love Addiction
    • Shopping and Spending Addiction
    • Other Addictions
    • Mental Health and Co-Occurring Issues
  • Blog & Resources
  • For Clients
    • Get Started
    • Locations
    • Contact
    • Common Questions
    • Consent Forms
    • Private, Confidential, and Discreet
    • Privacy Policy

Consent Forms

Consent Form

Prospective clients seeking to begin individual or group counseling at Jeremy Frank and Associates must sign and return the following consent form.

Choose the version that works best for you (PDF or Google Doc), and review suggested instructions for signing and returning the last signed page to us.

  1. JFA-Informed-Consent-for-Online-Telehealth-Groups-and-Individual-Counseling-rev

To sign and return the consent form (you only have to return the last page signed), there are several options that might work best for you described below. Let your clinician know how you’ll be sending the form back or ask them for assistance.

How to Sign and Return Your Consent Form

You can electronically sign documents in Preview, Adobe, Eversign, SmallPDF, or other programs you may know. You can also print, scan, and email the form to us. We also accept a photo of the signed form via email or text.

Additional Details:

  • Adobe – Open the document in Adobe and click the “Fill & Sign” icon. You’re then able to draw your signature using your trackpad, mouse, or touchscreen. After signing, choose “Save As” in the File drop-down menu and save the document as a PDF and email it to us.
    • Adobe Acrobat Reader (desktop program – download required)
    • Adobe Fill and Sign (mobile app – download required)
  • Eversign.com – A service for sending and signing documents (online software – no download required but must register for an account; allows up to 5 documents a month for free). Upload the PDF, drag and drop fillable fields, then enter your text and signature. After you complete the document, you can download it as a PDF and email it to us.
  • SmallPDF – A free electronic signature tool (online software – no download required). Upload the PDF, drag and drop fillable fields, then enter your text and signature. After you complete the document, you can download it as a PDF and email it to us.
  • Take a picture of it – If you have a printer, you can print out the document, sign it, take a picture, and then send us a picture of the form via email or text.

Contact Us With Any Questions

If you have any questions or require assistance, please call 215-356-8061 or message us through our contact form or by email.

Start Your Recovery Now

Let’s find out where you are right now and together we’ll choose the best approach so you can recover.

Schedule a consultation. Reach out today.

New Clients Start Here
Jeremy Frank & Associates
About
  • About
  • Meet the Therapists
  • Therapy Services
  • Our Approaches
  • Blog & Resources
  • Common Questions
  • Get Started
Specialties
  • Drug and Alcohol Addiction
  • Gambling Addiction
  • Gaming Addiction
  • Understanding Sex Addiction
  • Shopping and Spending Addiction
  • Mental Health and Co-Occurring Issues
Connect
  • Locations
  • New Clients Start Here
  • Contact
  • (215)356-8061
  • Email Us
  • 2401 Pennsylvania Ave
    Unit 1C52
    Philadelphia, PA 19130

  • 2 Bala Plaza
    Suite 13
    Bala Cynwyd, PA 19004

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Information on this website www.jeremyfrankassociates.com does not constitute a therapeutic relationship and should not be construed as clinical advice, counseling or therapy. We assume no liability for the information within this website or harm that may result from using, referencing, relying on, or decisions executed from its use. 

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