ALL FORMS | Canyon Pines

top of page

All Forms

Disclosures

Vicki Swab's Disclosure Statement

James Estes' Disclosure Statement

Laurie Liddick's Disclosure Statement

Lisa Goldberg-Grigg's Disclosure Statement

Hannah Klaassen's Disclosure Statement

Sarah Lewis' Disclosure Statement

Stephanie Kugler's Disclosure Statement

Jack Davenport's Disclosure Statement

Rachel Wagster Giamundo's Disclosure Statement

Catherine Thompson's Disclosure Statement

Jennifer Worcester's Disclosure Statement

Desiree Murray's Disclosure Statement

Lindsay Straka's Disclosure Statement

Sandy Malone's Disclosure Statement

General Forms

Please choose one of the following:

Client Information - Adult

Client Information - Child/Adolescent

Client Information - Couples/Family

Please complete all these forms:

Consent to Communicate PHI Electronically

Credit Card Authorization

Complete if you would like me to speak to another professional (Physician, Teacher, Etc.):

Release of Information

Additional form(s):

Consent to Video Tape

Teletherapy

Teletherapy Informed Consent Form

bottom of page