Patient Portal

New Patients:

​*Dr. Jacob has a secure, HIPAA-compliant online portal where new patient forms can be completed electronically. If you scheduled a new patient appointment, you should have receive an email with a link to set up your patient portal. ​If you have not yet received this portal link, please contact Dr. Jacob and provide her with your email address. Once you are an established patient, you can also use your patient portal to communicate with Dr. Jacob via secure messaging.
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​Please click the below button to access your patient portal.
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Patient Portal

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 Alternatively, you may print the new patient forms from below, complete them by hand, and bring them to your initial intake appointment. Forms completed by hand can also be scanned and uploaded to your patient portal, if preferred.
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​The following forms are to be completed prior to the first appointment. Other forms will be completed as needed.
- New Patient Form (Either Child or Adult)
- Informed Consent & Outpatient Services Contract
​- Acknowledgement of Notice of Privacy Practices

New Child Patient Form

New Adult Patient Form

Notice of Privacy Practices (Read Only)

Release of Information