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Forms for New Clients
Please Click on the Form Links Below and Right. Please review each form carefully, print them out, sign and date them and fax back to me at 760.494.7231. When you hear the voice recording go push the start key on your fax machine. Thank you! Please call me, if you have any questions.     

For new Client's Please print and fill  out the Client Intake Form, Credit Card Authorization, HIPPAA Form, and Client Fee Sheet.  Please be advised, I must have signed and dated forms prior to our first session.
If ou have any questions, please contact me at 760. 634.1704.  Thank you. Julieann

   
  Document
Adult's Release of Information Form
   
Additional Forms
Document
AD/HD Screening Checklist
  Document
Email Communication Release
Document
Consent for Children
Document
Life Coaching Questions
 



Home  |  About Me  |  Counseling  |  CHS Inc.  |  Life Coaching  |  EMDR  |  Consultation  |  Contact Me

Phone: (760) 634-1704  (760) 846-3234  Email: julieannmyers@mac.com
2047 San Elijo Ave # K Cardiff By The Sea, CA 92007

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Experience & Results.