Avedian Counseling Center

Forms

If you would like for your therapist to speak with anyone about your progress or treatment, you will need to complete the Release/Exchange of Information form below:

Release of Information (ROI) - digital

If you prefer to bring the completed form with you to your next session, you may print the following form and either fax the form to (818) 783-2927 or bring the completed form with you to your counselor.

Release of information (ROI) form - printable

If you plan to use your insurance, please complete the following form. The Avedian Counseling Center is considered an “Out-of-Network” provider.

Insurance information (digital form)

In Person session consent during COVID-19
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