These three (3) forms need to be completed before therapy can begin. Please download them, complete them, and return them to me via fax at (949) 756-9998 or when you come in for your first appointment. Or, if you prefer, you may fill them out in person when you arrive at the office:
- Disclosure Statement & Agreement for Psychotherapy Services
- Confidential Information
- Acknowledgment of Receipt of Notice of Privacy Practices (please sign after you read the "HIPAA Notice" on this website).
Please complete these forms as needed:
- Insurance Information (please complete if you wish to use insurance to pay for services).
- Debit/Credit Card Authorization (please complete if you wish to use your debit or credit card to pay for services).
Please complete this form in the first few weeks of therapy:
Please complete this form if you would like me to coordinate care with outside parties (e.g., psychiatrist, physician, etc.):
This article will help familiarize you with Psychodynamic Psychotherapy. Please read it at your leisure:
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