Helpfull Forms

If you're a new client, please complete the following forms and bring them to your first Counseling or Consulting appointment. 
 

• Limits of Confidentiality/Counseling Cancellation Policy
  

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of Counseling information:

• Authorization to Disclose Information Form

Limits of Confidentiality/Therapy Cancellation Policy
Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.

Ky Washington AS, Psychology ,
LAADC, ICADC,CADC III , SAP #LCi04640314

LAADC # LNR 520311( NON GOVERNMENT)
CADC # 5030510
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