Please FILL OUT the following forms if applicable and bring them with you to your first appointment. If you have any questions while filling them out, please feel free to contact me via the “Contact” page or call (530) 887-8455. Also, you may simply bring forms to your first appointment and we can go over any questions at that time.
- Information Sheet (all clients)
- Symptoms (all clients)
- Informed Consent (INSURANCE clients only, 2 pages)
- Informed Consent (PRIVATE PAY clients only, 2 pages)
- Hypnotherapy Consent (HYPNOTHERAPY clients only)
- Notice of Privacy Practices (all clients print and sign)
Please READ the following information prior to first appointment:
- Notice of Privacy Practices Page 1 (READ ONLY)
- Notice of Privacy Practices Page 2 (READ ONLY)
- Notice of Privacy Practices Page 3 (READ ONLY)
- Notice of Privacy Practices Page 4 (READ ONLY)
Insurance Claim Form:
Barbara Van Felix 