The following forms are provided for your convenience. Please complete them prior to our first appointment. This will allow us to spend more time during our first session on discussing your goals and expectations for our work together, rather than on completing paperwork.
Consent Form
This form above provides information about our services, fees, billing and confidentiality. Please read and initial all sections and sign on last page. Feel free to discuss any questions you have regarding the content of this document during our first session.
Individual Intake
Please complete the intake form for adults, and bring with you to your appointment.
Child/Adolescent Intake
Please complete this intake form for a minor - child/adolescent and bring to appointment
Couples' Intake
This intake for is for couples. Bring with you to your appointment.
HIPAA Privacy Notices
This form is for your information. It provides an explanation regarding the use and storage of your private information by Newport Beach Family Therapy where I practice.
Payment Authorization Form
This form provides various automatic payment options for your convenience so that you may get the most out of our time together without having to spend time from our sessions to take care of payment of services.
Note: To download Adobe Acrobat Reader for free, click here.
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