Please bring these forms filled out with your information to your first session:
Forms
Consent for Treatment
Authorization to Disclose
Protected Health Information
Request to Receive Copy of
Protected Health Information
Registration for a Minor
Health Insurance Claim Form
Other forms you may need:
Mary Roy, MFT
Mary Roy, Marriage and Family Therapist
3184A Old Tunnel Road
Lafayette, CA 94549
(925) 932-5072