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“The truth is what you perceive the truth to be. Change your story and you change your life.”

FORMS & PRIVACY

Please note that that the relationship between a therapist and client is legally protected. No personal information that is shared in our sessions can be disclosed without your permission.

Exceptions To This Include:
As a therapist, I am a mandated reporter and am legally obligated to immediately report suspected child or elder abuse or neglect. However, a therapist is NOT obligated, or in fact able, to breach confidentiality in the case of abuse of an adult unless I suspect that the abuse can result in serious bodily harm.

If I know that a client is threatening serious bodily harm to another person, I must contact the police and give them information about the intended victim and nature of the threat.

If I believe that a client intends to harm himself or herself, I must take steps to attempt to collaborate with my client to assist him or her in insuring his or her safety. In the event that a client can not or will not cooperate, I will take actions without his or her permission to protect the client in accordance with the law to ensure the client’s safety and the safety of others.

For further information about the laws governing confidentiality, privilege, and psychologists in general, please go to the California State Board of Psychology www.psychboard.ca.gov

To all new patients: please download and fill out the following forms. Please fill out the bio form ahead of time and email or fax it back to me (to FAX #310 496-0308). Doing so ahead of time will help me and will save us valuable session time. Please also read the office policies and notice of privacy practices before our session. This will allow us more time to talk during our initial session. Thanks!

New Client Bio (Word)
Notice of Privacy Practices (Word)
Office Policies General Info (Word)
Telemedicine Consent (Word)
Hypnotherapy Agreement (Word)