Call 408-628-0532 or Text 408-579-9806 now!
Informed Consent Agreement for Minors:
Please complete the form for the therapist you are scheduled to see!
Please complete the form for the therapist you are scheduled to see!
| Ingrid Higgins, LMFT |
| Stephanie Chase, LMFT |
| Sharmaine Cardenas, ACSW |
| Nelson Saez, ACSW |
| Martha Perez-Quintanilla, AMFT |
| Mitchell Gale, AMFT |
Informed Consent for Adults:
| Ingrid Higgins, LMFT |
| Stephanie Chase, LMFT |
| Sharmaine Cardenas, ACSW |
| Nelson Saez, ACSW |
| Martha Perez-Quintanilla, AMFT |
| Mitchell Gale, AMFT |
Telehealth Consent Form:
| Consent for Telehealth |
Intake Form:
| Intake Form Adult |
| Intake Form Minor |
Release of information:
| Authorization to Exchange Information |
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.
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 |