INTAKE FORMS to Be Completed Prior to Treatment

 

Identify the service you are seeking to determine the correct forms to print and complete prior to your first appointment.

2. Child or Teen for Individual Therapy

 

  • New Client Form

  • Child or Teen Information Form 

  • Consent to Treat a Minor

  • Receipt for Privacy Practice

  • HIPAA Authorization Form (Optional)

  • Release of Information (Optional)

4. Mindfulness Skills Group

 

Robyn Coughlin, LCSW   619-997-5310                                                                                                                                                8885 Rio San Diego Drive. STE: 365 San Diego, CA 92108