Coaching Forms

Before your first appointment, please download and complete the following forms:

Client Questionnaire
Coaching Agreement
Coaching Readiness
Priority Ranking Exercise

If your first appointment is a face-face appointment, please bring the completed forms with you.

If your first appointment is a phone or “live-chat” appointment, please either fax (916-786-3080) or mail (1380 Lead Hill Blvd., #110, Roseville, CA 95661) the completed forms to me in time for me to receive and review them prior to the first appointment.

If you have any questions about any of these forms, please call me at 916-956-7762.

Psychotherapy Forms

Before coming to your first appointment, please download and complete the appropriate forms. For adults, please complete the “Client Information” form, the “Office Pollicies and General Information” form, and the “Authorization to Release Information and Records” for your medical doctor and, if appropriate, your psychiatrist.

Please also read over the “Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information (HIPPA)” and then download, print out and sign the “Summary Information Form” and bring it with you to your first appointment.

For minors, the “Consent for Treatment of a Minor” form must also be printed out and signed by at least one of the biological parents.