Please Note: I am currently providing ONLY telehealth video therapy sessions via a HIPAA-compliant videoconferencing service to California clients. If interested, please let me know or click here for more information, and I pray you and your family stay safe during these challenging times.
Both state law and fair ethical practices require therapists to establish certain contracts between themselves and their clients, so as to provide you the best treatment possible. It is also important that I gather information regarding your history as well as your current concerns. To accomplish this I use the following client forms you can download, fill out, and bring to your first session. I will go over them with you at that time.
- Intake Form for Adults
- Intake Form for Minors
- Office Policies and Treatment Agreement
- Authorization for Two-Way Release of Information
- Authorization for Two-Way Release of Information Concerning a Minor
- Notice of HIPAA Policy
- Telemental Health Informed Consent
- CMS-1500 Claim Form
- Beck’s Depression Inventory
- Burns Anxiety Inventory
Reach out and connect with me at therapywithtricia@gmail.com or call me anytime at (714) 974-1621, to ask any questions, have a free phone consultation, or set up an initial office consultation. I look forward to hearing from you.
Office (714) 974-1621 / FAX (714) 485-2316 / E-mail
Tricia Buttkus, LCSW – Licensed Psychotherapist
20409 Yorba Linda Blvd, Suite 108, Yorba Linda, CA 92886
Proudly serving Orange County and parts of Riverside County, including Anaheim, Corona, Riverside, Anaheim Hills, Fullerton, Tustin, Brea, Orange, Villa Park, Placentia, and Yorba Linda.