If you're a new client, please complete the following forms and bring them to your first therapy session.
- Electronic Biographical Information Intake Form - Word Format
- Electronic Biographical Information Intake Form - PDF Format
- HIPAA Notice of Privacy Practices
- HIPAA Release Form
- Client Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
- Short Intake Form
- Office Policies & General Information Agreement for Psychotherapy Services or Informed Consent for Psychotherapy
- Self-Pay Agreement
- Telepsychology (Teletherapy) Consent Form
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:
Note: To download Adobe Acrobat Reader for free, click here .
You can also send them after asking me to turn my fax on, to my private fax line at: 831-477-2818 or mail them to me so that I receive them before our first session.
Please email or call me for the street number, to get directions, or to turn on my fax machine.
[email protected]
Marianne Gabriel Mejia, MA, LMFT
Hidden Valley Road, Soquel, CA 95073
You can also text me at: 831-607-9130
|
|
|
Learn to find happiness inside you.
