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  • Information for New Clients

Please print out our Intake Packet

Prior to your appointment:

  1. complete the “Client Information Form"

  2. read over the “Client Services Contract”

  3. read over the “California HIPAA Notice”

  4. bring the entire packet to your appointment

I look forward to meeting you and working together. If you need to make any changes, please call as soon as possible.

To download, right click on the PDF logo or title and select "Save Target As"
To view only, left click on the PDF logo or title and select "Open"

Intake Packet (total 8 pages)

Bring this entire packet to your first appointment

Map
Quest

 Map of our location
Map
Quest		 For Driving Directions from Your location
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Information & Directions (2 pages)
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Client Information Form (2 pages)

Please fill this out as completely as possible and bring to your appointment.
Adobe_Reader.gif (224 bytes) Client Services Contract (2 pages)

Please carefully read this over, sign and bring to your appointment.

Feel free to write down any questions you have and bring them with you to your appointment. I will review this with you when we meet and am happy to answers any questions you may have.

Adobe_Reader.gif (224 bytes) California HIPAA Notice (2 pages)

Please read this over. This copy is for you to keep.

   
   
   

FOR OFFICE USE ONLY · · · 

Adobe_Reader.gif (224 bytes) Authorization to Release Information To ...
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Adobe_Reader.gif (224 bytes) Medicare Opt Out Agreement
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