In order to take advantage of our time together, please print, complete, and bring in the following
documents to your initial consultation.

• Informed Consent
• Information Form
• Checklist of Concerns
• Client Concerns Form
• Confidentiality and Supervision
• HIPPA Regulations

Please print, complete, and bring in the following Electronic Pay Authorization forms to your initial consultation.

• Security and Privacy
• Electronic Pay Authorization

Need More Information?

To schedule an appointment or to obtain additional information about services, please email or give me a call.

I can be reached at

805.234.7409

or by email at

Kandace@therapeuticbenefits.com