Carole Vance, Licensed Marriage & Family Therapist

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The following forms can be completed ahead of time or at the first session. They are standard forms for the client's protection as well as for the basic needs of therapy. These forms are reviewed in more depth at the first session according to the California Behavioral Board of Science and HIPAA regulations. Review takes about 15 minutes of the first session.

1. Intake Form. Please complete this form, then either email to or print and bring

    to the first session. This form (as with all medical records including each of the forms required for therapy) is kept

    confidential  Intake Form

2. HIPAA Form. This form is for the client's records. It explains medical record privacy laws   HIPAA Form

3. Receipt of HIPAA Form: This form indicates that the client has received HIPAA Privacy Laws (#2). Please 

    sign, then either email to or print and bring to the first session. 

    Receipt of HIPAA Form

4. Cancellation Policy: This form describes the policy around cancelling or rescheduling an already established

    appointment. Please sign then either email to or

    print and bring to the first session. Cancellation Policy