Dr. Valerie Correa

The links below are for forms that can be downloaded, filled out and printed. I will tell you which forms I require you to have filled out before your first appointment. All forms are in Adobe Acrobat (PDF) format. If you do not have Adobe Acrobat, please visit: http://www.download.com/Adobe-Acrobat-Reader/3000-2145_4-10170808.html to get a copy.

1. New Client Information Form. (Click on the link below):

This is a form required for all new clients to gather some general information.

New Client Information Form (Click here to download form)

2. Comprehensive Intake Form (Click the link below): and either fill the form out electronically or print it and fill it out by hand. You will need to bring a signed original to our first appointment.

Comprehensive Intake Form (click here to download form)

3. Childhood History Form (click on the link below): This is a form asking for information about your child and reasons for bringing him/her to therapy. It is also a request to attach: School Records, Report Cards and Psychological Testing.

Childhood History Form (Click here to download form)

4. Problem Checklist (Click on the link below): This should be filled out by all clients before their first appointment. Adults and adolescents can fill it out themselves, if you are bringing your child in that is too young to comprehend the meaning, please fill it out by your observation of each item.

Problem Checklist (Click here to download form)

5. Office Policies & Professional Disclosure Statement. (Click on the link below):

This is also required for you to download and print so that you can read and understand my policies and professional disclosure. Please sign the last page acknowledging that you have read and understand the policies. You are welcome to ask questions about anything that you don't understand.

Office Policies and Disclosure Statement (Click here to download)

6. Credit Card Authorization Form.(Click on the link below): If you wish to pay by credit card, please click the link below, print this form and bring it signed to your next appointment:

Credit Card Authorization Form (Click here to download)

7. Release of Information Form (Click the Link Below): It is often important for me to communicate with other professionals about specific aspects of therapy in order to coordinate a treatment plan. This form gives legal permission for that communication to take place and will be discussed in session before you sign it.

Release of Information Form (Click here to download form)