Faith-Based and Spiritual Counseling, Counselor, and Therapist in Long Beach/Seal Beach, CA
If you're a new client, please complete the following forms, provide a front and back copy of your insurance card, Primary insured's name, address, date of birth and phone number. Please e-mail the information to [email protected] two days prior to your first scheduled therapy session with licensed Marriage and Family Therapist Elizabeth Middleton.
- Client Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
- Authorization to Disclose Information Form
|
|
|
|
|
Note: To download Adobe Acrobat Reader for free, click here .
