FORMS

If you’re a new client, please complete the “Client Intake Form” & “Disclosure Statement Agreement for Services” forms and bring them to your first appointment/therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this “Authorization to Disclose Information” form to authorize release of psychotherapy information.

Please read and review this “Privacy Practices” form.  This explains your privacy rights.  

If you are a client who will be working with a Cardiff Counseling Center Intern, please complete the “Intern Counselor Release” and bring to your first appointment/therapy session.

If you have any questions regarding these forms, their contents, or what you need to print, fill out and sign, please call or email me at:

760-732-1539  bonnie@cardiffcounselingcenter.com