In Take Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

906 Sycamore Ave.
S uite 100
Vista, Ca. 92081

Phone: 760-580-7708
Fax: 760-941-6668

Client Psychotherapy Intake Form

Fees & Length of Therapy

Limits of Confidentiality/Therapy Cancellation Policy

Informed Adult Consent

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form

HIPPA Notification Release

Note: To download Adobe Acrobat Reader for free, click here .

NOTICE TO CLIENTS The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at , or by calling (916)574-7830.

Schedule Appointment

Start your new path in life and be the change today!

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Helpful Forms

Click here to view and print forms for your appointment.

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