New client forms
Forms for your first session.
If you are coming in as a new client, please fill these out ahead of time and bring them with you to your first session. Doing the paperwork at home means the first hour can be spent on you rather than on a clipboard.
Client forms
- Client Intake Form (PDF)
- Limits of Confidentiality and Cancellation Policy (PDF), which covers what confidentiality does and does not protect, and our 24 hour notice policy for changing an appointment
- Consent for Treatment and Financial Agreement (PDF)
- COVID-19 In Person Consent Form (PDF)
- Authorization to Disclose Information (PDF)
The Authorization to Disclose Information form is only needed if you would like us to coordinate your care with another provider, such as a psychiatrist, your primary care doctor, or a previous therapist. Nothing is shared with anyone without your written permission, and you can withdraw that permission at any time.
Not sure which ones apply to you? Bring what you can and we will sort out the rest together. Nobody has ever been turned away for arriving with incomplete paperwork.
If the PDFs do not work for you
These are downloadable PDF documents, and some of them are not built for screen readers. If that makes them difficult or impossible to use, please call us at (949) 357-3587 or email Kay@LagunaBeachCounseling.com and we will get you the same information in a format that works, including going through the forms with you over the phone or in person at your first session. You will not be at any disadvantage for needing them a different way.
Notice to clients: how to file a complaint
Beginning 1 July 2020, California mental health counselors are required to give every client a notice stating where a complaint can be filed. That requirement comes from AB 630 (Chapter 229, Statutes of 2019). Here is ours.
The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the Board online at www.bbs.ca.gov, or by calling (916) 574-7830 if you have a complaint.
A printable copy is available here: BBS Required Notice to Clients (PDF).
Not a client yet? Start with a call.
None of this paperwork is needed before the free 15 to 20 minute Get to Know Us call. The forms come later, once you have decided we are the right fit.
Free and confidential. Be seen within 24 hours.
Navigating Life's Waves Together