Dr. Suzanne Cleck, PsyD, LMSW, LLP
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248-421-1553

Forms


Please complete one of the following intake forms and bring them to your first appointment, along with your completed self report.

Child and Adolescent Intake

Parent or guardian, please answer the questions to your best ability. If you are not sure, please leave the answer blank.
child_behavior_checklist__1_.pdf
File Size: 1410 kb
File Type: pdf
Download File

Adult Intake

Please answer the questions to your best ability. If you are not sure, please leave the answer blank.
cleck_2020_adult_intake.pdf
File Size: 105 kb
File Type: pdf
Download File

Self Report

Please answer all questions on this form.
cleck_oq30_adult_self-report.pdf
File Size: 83 kb
File Type: pdf
Download File

Home
About
Contact
Dr. Suzanne Cleck, PsyD, LMSW
28345 Beck Rd., Suite 305
Wixom, MI 48393
248-421-1553
  • Home
  • About Dr. Cleck
  • Contact
  • New patient forms
  • Blog
  • The Practice