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|
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Ky Washington AS, Psychology ,
LAADC, ICADC,CADC III , SAP #LCi04640314
LAADC # LNR 520311( NON GOVERNMENT)
CADC # 5030510
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