license #MFC 22942

Personal and Family Therapy         By a Board-licensed Professional

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"Because sometimes you need a NEW PERSPECTIVE on the problem."

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(916) 966 - 7300      1845 Iron Point Road, Suite #180,  Folsom, CA 95630

FORMS needed for your first session:
(Instructions: after printing the consent form for you or your child, use the back button on your browser to open up the Office Policies.)

CONSENT = Your permission for counseling to begin

OFFICE POLICIES  = Important information about charges, confidentiality and more

CONSENT FOR MINOR = Your permission for your child's counseling to begin

Optional FORMS:

(Instructions: after printing the form you need, use the back button to return to additional forms.)

INSURANCE RELEASE = If you are using insurance

INFORMATION RELEASE = If you want David to consult with someone

HIPAA NOTICE = Federally required notice if patient information is transmitted electronically

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Types of counseling or psychotherapy offered:

• Marriage counseling = Marital therapy = Couple's therapy = Relationship counseling
• Psychotherapy = Counseling
• Family counseling
• Individual counseling = Individual psychotherapy
• Hypnotherapy
• Mental health = Wellness
• Child counseling = Play therapy
• Sand tray therapy = Child therapy

• Psychotherapist = Counselor = Therapist