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. This form can be completed, then either emailed to or printed and brought

    to the first session. This form (as with all medical records) 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). It can be 

    signed, then emailed to or printed and brought to the first session. 

     Receipt of HIPAA Form