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Forms Print, Fill Out & Bring In


Posted below is the necessary form for you to fill out and bring with you when you come for your appointment. It will take about 20-25 minutes to fill out the intake forms, but it will allow us to cover a lot of material during your first appointment, and utilize our time together more effectively.

Please download the INFORMED CONSENT AGREEMENT & OFFICE POLICIES here »
Please download the CREDIT CARD AUTHORIZATION FORM here »
Please download the CLIENT INTAKE FORM here »
Click here for the AUTHORIZATION TO EXCHANGE INFORMATION Form » 

Please read the forms carefully, print and fill out completely, and note any questions that you would like to have answered. Please also fill out the intake form (very important), and bring it, along with the therapists’ copy of the informed consent agreement to your first appointment, I will be asking you to sign them when you come in.

My office is located at 1221 Pleasant Grove Blvd. Suite 150, Roseville Ca 95678. When you arrive, please have a seat in the waiting room, and I will come out to greet you when I am finished with my previous session.

In instance when you need to reschedule your appointment, please be sure to let me know at least 24 hrs. in advance, otherwise I must charge you your regular full session fee.

I look forward to meeting you,
Sincerely,
Eva Ghioni, M.S./LMFT