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  • HOME

  • OUR STAFF

    • Rob Adelman, M.S.W
    • Rick Deitchman, Ph. D.
    • Jonathan Gould, Ph. D. ABPP
    • Melinda Harper, Ph. D.
    • Randy Wall, Ph. D.

  • SERVICES

    • Assessments
    • Forensic Services
    • Group Therapy
    • Organizational Consulting
    • Public Speaking Engagements
    • Transition to University
    • Transition to Work

  • CONTACT US & DIRECTIONS

  • FAQs

  • PRACTICE FORMS

  • LIBRARY

  • More

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    Therapist Agreements

    Robadelmanservice_agreement 6_9_2022.pdf

    Rob Adelman

    Services Agreement

    deitchmanserviceagreement5_2022.pdf

    Rick Deitchman

     Services Agreement 

    Dr. Wall's Outpt. Services Agreement - rev. jan 12.pdf

    Randy Wall

    Services Agreement

    R Deitchman Social Media Policy.pdf

    Rick Deitchman

     Social Media Policy

    Melinda Harper Services Agreement.pdf

    Melinda Harper Services Agreement

    HarperSocial Media Policy 5_2016.pdf

    Melinda Harper

    Social Media Policy

    GOULDOPServiceagreemnt.pdf

    Jonathan Gould Services Agreement 

    Basic Information Forms

    Child Adol Info Sheet.pdf

    Child/Adolescent

    Information Form

    adultinformation.pdf

    Adult Information Form

    Authorization to Release information.pdf

    Authorization to Release Information

    Group Therapy & Assessment Forms

    psychological assessment.pdf

    Psychological Assessment

    menstherapygroupinformation 2_2022.pdf

    Men's Group Therapy Information

    Statement of Understanding

    STATEMENT OF UNDERSTANDING.pdf

    For custodial fitness evaluations

    Download Statement for review

    Melinda Harper Informed Consent for Telepsychology.pdf

    Melinda Harper

    Tele-Psychology Informed Consent

    Teletherapy Informed Consent

    ​

    Teletherapy Informed Consent Form.pdf

    Teletherapy Informed

    Consent Form

    CPCG_edited_edited.png

    Address:  

    Charlotte Psychotherapy and Consultation Group

    417-A S. Sharon Amity Road

    Charlotte, NC  28211

     

    Phone: 704.364.0452

    Fax: 704.364.5481

    ​

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    OUR STAFF

    SERVICES

    CONTACT US & DIRECTIONS

    FAQs

    LIBRARY

    Rob Adelman M.S.W.

    Rick Deitchman Ph. D.

    Jonathan Gould Ph. D.

    Melinda Harper Ph. D.

    Randy Wall Ph. D.

    Psychotherapy Services

    Coaching & Organizational Consulting

    Group Therapy

    Public Speaking Engagements

    Forensic Services

    Transition To University (T2U)

    Transition to Work (T2W)

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