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
Limits of Confidentiality/Therapy Cancellation Policy
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
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 www.bbs.ca.gov , or by calling (916)574-7830.