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