Intake forms for new consultations must be completed and emailed prior to your appointment.
Please download and save the appropriate intake form below to complete and email to our Clinical Director at [email protected] or email to the appropriate intake coordinator.
- Adult Intake Form
- Child Intake Form
- Couples Intake Form
- Acuerdo de Consejero-Cliente y Forma de Consentimiento
If you would like us to coordinate care with your psychiatrist, primary care physician, or your child's school, please use our Authorization to Disclose Information Form below to grant us permission to do so. You can bring this form to us during your next office visit.
Per company policy, clinicians or office staff are not permitted to speak to your attorneys with this form. All legal representatives must secure a subpoena to speak with a member of our practice. See our agreement for associated fees for communicating with attorneys and related court retainer fees.
Your mental health record is accessible to you upon request. If you request a superbill or "summary of receipts" or a copy of your records, there is a $45 administrative charge for the first 20 pages and $1 per page thereafter.
If you are being seen as a couple, two copies will be given to each separate client. You are allowed one free mental health record per year when your request is mailed directly to a federal governmental agency.
We are not able to write work notes for time off. We also cannot complete disability evaluations or work compensation cases.
Credit Card form - If you are an established client, you may update your primary payment method by downloading and emailing the completed Credit Card form below to [email protected]
Note: To download Adobe Acrobat Reader for free, click here.