New Client Forms
If you're a new client, please complete the following forms (1-7) and bring them to your first therapy session (complete 4 for an adult and 5 for minors).
1. Informed & Consent
1a. Teletherapy Consent
2. Confidentiality and Disclosures
3. Personal Information
4. Medical History Adults
5. Medical History for Minors
6. Symptom Checklist
7. HIPPA Notice of Privacy Practices
8. Authorization to Disclose Information
New Client Forms
If you're a new client, please complete the following forms (1-7) and bring them to your first therapy session (complete 4 for an adult and 5 for minors).
1. Informed & Consent
1a. Teletherapy Consent
2. Confidentiality and Disclosures
3. Personal Information
4. Medical History Adults
5. Medical History for Minors
6. Symptom Checklist
7. HIPPA Notice of Privacy Practices
8. Authorization to Disclose Information
Please contact my office if you have any questions.
Lia Roy Nanda, LMFT
(818) 515-4576
lialistens@yahoo.com