If you would like for your therapist to speak with anyone about your progress or treatment, you will need to complete this form and either bring it with you, or fax it to (818) 783-2927.

Authorization For The Release Or Exchange Of Information

If you plan to use your insurance, please complete the following form and bring it with you to the session. Please remember that I am not on any panels which means I would be an “Out- of- network” Provider.

Insurance information

In Person session consent during COVID-19

Release of information (ROI) form – printable

Release of Information (ROI) – digital

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