Campbell Teen & Family Therapy
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Informed Consent Agreement for Minors:
Please complete the form for the therapist you are scheduled to see! 
Ingrid Higgins, LMFT
File Size: 194 kb
File Type: pdf
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Stephanie Chase, MFT
File Size: 194 kb
File Type: pdf
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Runjhun Pandit, APCC
File Size: 196 kb
File Type: pdf
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Tandra Childress, AMFT
File Size: 197 kb
File Type: pdf
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Nelson Saez, ACSW
File Size: 194 kb
File Type: pdf
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Informed Consent for Adults: 

Ingrid Higgins, LMFT
File Size: 162 kb
File Type: pdf
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Stephanie Chase, MFT
File Size: 88 kb
File Type: docx
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Runjhun Pandit, APCC
File Size: 163 kb
File Type: pdf
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Tandra Childress, AMFT
File Size: 164 kb
File Type: pdf
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Nelson Saez, ACSW
File Size: 162 kb
File Type: pdf
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Intake Form:
Intake Form Adult
File Size: 91 kb
File Type: pdf
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Intake Form Child
File Size: 95 kb
File Type: pdf
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Release of information:
Authorization to Exchange Information
File Size: 312 kb
File Type: pdf
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Credit Card Authorization:
Have a teen who will be driving themself to therapy?  We can keep a card on file, so they don't have to remember to bring payment anytime!  If you choose to do this, please complete the form and email or fax it to your therapist.  
Credit Card Authorization
File Size: 156 kb
File Type: pdf
Download File

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