To help us serve you better, please download these intake forms. Fill in the form digitally (use the Chrome or Safari browsers, as Firefox will not work), save it, and email it to: firstname.lastname@example.org:
• Adult Intake Form (requires Adobe Acrobat Reader)
• Child Intake Form (requires Adobe Acrobat Reader)
You can also print the forms, fill them in and mail them to the address included on the form.
1. The purpose of this email contact is to provide information that may not be addressed on our website. It is not for individual psychological advice. You may call any practitioner directly if you have a specific question about them or their services by accessing our company names directory.
2. Please note that while we make all efforts to maintain confidentiality, email form submissions are not encrypted. Therefore, we suggest that you please do not include any personally identifying information (e.g. surname, address, etc.). For your privacy, we will not retain email addresses.
3. Although we try to check email on a fairly regular basis, there may be a delay in our response time. We will not acknowledge any requests for individualized treatment advice for a crisis situation by e-mail. These types of situations are better dealt with by calling 911; the Community Crisis Response Service (310-COPE)- (310-2673)-Do Not dial 905; or by going to your nearest hospital emergency department.
4. By sending your e-mail, you acknowledge that you have read, understand, and agree to this Disclaimer.
In order to maintain your confidentiality, all detailed responses will be through telephone contact.
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