Video-based therapy for teens and adults in California.
Forms
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For your convenience, I have provided links below for the forms required for seeking therapy, consultation or tutoring with me.
As indicated by the type of service you are seeking with me, please download and print the pertinent forms required for treatment. If you are able, please complete these forms and bring a copy of each to your first session. Doing so just saves a bit of time in our first session. If you can't print these forms for any reason, or wish to talk with me about them in person, I do have copies in my office and I’m happy to answer any questions you may have.
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The information in these forms asks questions about you and/or your family and outlines specifics to my work and related policies. Your understanding of this information and signature will be required before we initiate our work together.
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Other forms may be required as we proceed. I will go over any necessary forms with you and provide these below as a reference for you to either print out as necessary, or read online:
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For All Clients
Client Informed Consent Handout
Privacy Policies
Acknowledgement of Receipt of Privacy Policies
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Individual Therapy
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Family Therapy/Caregiver Consultation
Caregiver Consent Form
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Child/Adolescent Therapy and/or Therapeutic Tutoring
Therapy with a Minor Form
Child History Information Form
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Helpful Collaborations
If you would like me to work with or consult to any school staff, extended family, other mental health or medical care providers, etc; please print a Release of Information form for each contact person. This will grant me permission to communicate with these specified people on your behalf. Collaborations can be an important piece of my work with you and your family. You can always rescind permission for these collaborations at any time. This collaborative part of my work, if you choose it, can be a topic of conversation in our work together at any point.
Release of Information Form