If you are a new client, please download, print, read, fill out, and sign the following forms and bring them with you to your first therapy session:

1. Consent for Treatment
   

2. HIPAA Notice
   

3. Billing Information Form
   

If you would like me to coordinate care with another provider (for example, your psychiatrist or primary care physician), please fill out the information of the provider on this form to authorize exchange of information:

1. Authorization to Exchange Information
   

Employee Assistance Program Clients

If you are a client who has been referred to me through an employee assistance program (EAP), please download, read, fill out, sign, and bring the following forms with you to your first session:

1. EAP Consent for Treatment
   

2. HIPAA Notice
   

3. EAP Information Form
   

If you have questions about any of these forms, please call 310.922.1698, email, or ask me when we meet.

Welcome

Forms for New Clients