ALL participants need to read, fill out, sign and submit ALL forms below.
If you and Rosario have already spoken and have agreed to schedule an appointment, the office needs to
first receive your forms.
Please call us when you have completed the forms and we will schedule your appointment then.
Form A is for a new client who seeks individual sessions; or the identified client who is coming with a family member or a friend. When the client is a minor, the parent should only fill out Form A, if the child needs it; otherwise, allow the child, or adolescent, to fill it out its own form, or with minimal guidance.
Form B is for any additional participant, like a spouse or a child’s parent (when the client is a child, both parents will need to fill out their own form B, on themselves, too). Form B is about yourself, not the client. Afterwards, if willing, please fill out another about the client and vice-versa.
Form C is a release of information, in case information has to be obtained or shared about you to a third outside party (in case of a couple or family session; one per person).
Read these forms carefully, fill them out completely, or put n/a, to help Rosario review the information with you and maximize session’s time.
Fill all forms directly* on this website, unless you prefer to print them (call us for email directives; the office will send you an encrypted email and you reply and attach the completed PDF)
*Directly submittable forms in English and in Spanish, respectively:
Form A: Client Psychotherapy Intake Form/ English https://hushforms.com/ortigaocounseling-a
/ Spanish https://hushforms.com/ortigaocounseling-1
Form B: Additional Participants Intake Form/ English https://hushforms.com/ortigaocounseling-b
/ Spanish https://hushforms.com/ortigaocounseling-2
Form C: https://hushforms.com/ortigaocounseling-c
Printable forms (if you prefer the email-of-one-PDF option):
Form A: Client Psychotherapy Intake Form - English/ Spanish
Form B: Additional Participants intake forms - English/ Spanish
Form C: Authorization for Release of Information- English
Note: To download Adobe Acrobat Reader for free, click here