Dr.Franklin.Carvajal@gmail.com
310-621-4755

Consent for Services / HIPAA – FORMS

Forms

New client informed consent — Please fill this out, read, sign, and bring to your first session. This form explains the therapy process.  If you have any questions, please feel free to ask them at your first session. (You can fill this out on your computer, if you like, and then print it.  Please do not email, for privacy reasons.)

Client information form — Please fill out this form as completely as possible.  It will help us use our first session more productively, and may help you clarify what your goals for therapy are.  If you are unsure about any of the questions, please feel free to discuss this.  (You can fill this out on your computer, if you like, and then print it.  Please do not email, for privacy reasons.)

Acknowledgement of Receipt of NPP — Please sign and bring to first session.  As of April 14, 2003, we are required to ask for this form, which documents that you have read the Notice of Privacy Practices below.

Notice of Privacy Practices (NPP) — As of April 14, 2003, we are required by federal law to notify you of our privacy practices.  (These are the same type of forms that every medical professional must provide.  We have tried to make ours very clear and understandable.  Please be sure to ask if you have any questions about this form.)