Oak Creek Relational Counseling Center
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  • Meet Our Therapists
    • Julie Beach (Trainee)
    • Tiffany Castillo (Trainee)
    • Sara Diaz (Trainee)
    • Madison Gluck (Trainee)
    • David Libby (Associate)
    • Donna V. Norona (Associate)
    • Dawn Orlando (Associate)
    • Hanna Ma (Trainee)
    • Maddy Mellema (Associate)
    • Jennifer Mellin (Associate)
    • Leila Mohajerany (Associate)
    • Angelina Rinaldi (Trainee)
    • Tasal Sherzad (Associate)
    • Desiree Tatarazuk (Trainee)
    • Francis Toal (Associate)
    • Stacey Watson (Associate)
    • Sara Zavala (Associate)
  • Forms
  • LEARN
    • Resources
    • CBT Homework Packs
    • Blog
  • Contact Us
  • Home
  • ABOUT THE CENTER
    • About Oak Creek
    • Working with OCRCC
    • Telehealth
    • Couples Therapy Pleasant Hill
    • A Partnership Opportunity for Medical Practices
    • Directions
    • Take a Tour
    • Payment Methods
  • Meet Our Therapists
    • Julie Beach (Trainee)
    • Tiffany Castillo (Trainee)
    • Sara Diaz (Trainee)
    • Madison Gluck (Trainee)
    • David Libby (Associate)
    • Donna V. Norona (Associate)
    • Dawn Orlando (Associate)
    • Hanna Ma (Trainee)
    • Maddy Mellema (Associate)
    • Jennifer Mellin (Associate)
    • Leila Mohajerany (Associate)
    • Angelina Rinaldi (Trainee)
    • Tasal Sherzad (Associate)
    • Desiree Tatarazuk (Trainee)
    • Francis Toal (Associate)
    • Stacey Watson (Associate)
    • Sara Zavala (Associate)
  • Forms
  • LEARN
    • Resources
    • CBT Homework Packs
    • Blog
  • Contact Us

Client Forms

Download and complete your intake forms.

All forms must be completed and returned to your therapist before your first session can begin. Download the packet that matches your service type below. If any form is inaccessible to you, let your therapist know and they will make accommodations.

Before your first session: Download all forms in your section, complete them, and return them to your therapist. If you're unsure which packet applies to you, ask your therapist.

Individual Therapy Couples Therapy Children & Teens Formularios en Español Additional Forms
□

Section 1

Individual Therapy

Client Informed Consent

PDF · 202 KB

↓ Download

Adult Intake Form

PDF · 226 KB

↓ Download

Telehealth Consent Form

PDF · 41 KB

↓ Download

CAMFT Notice of Privacy Practices

PDF · 43 KB

↓ Download

CAMFT Acknowledgment of Receipt of Privacy Practices

PDF · 85 KB

↓ Download

Covid-19 Release of Liability

PDF · 124 KB

↓ Download
□

Section 2

Couples Therapy

Each partner should complete the Adult Intake Form and Informed Consent separately. The Couples Intake Form is completed together.

Client Informed Consent

PDF · 234 KB · Complete separately, each partner

↓ Download

Adult Intake Form

PDF · 226 KB · Complete separately, each partner

↓ Download

Couples Intake Form

PDF · 214 KB · Complete together

↓ Download

Telehealth Consent Form

PDF · 41 KB

↓ Download

CAMFT Notice of Privacy Practices

PDF · 43 KB

↓ Download

CAMFT Acknowledgment of Receipt of Privacy Practices

PDF · 85 KB

↓ Download

Covid-19 Release of Liability

PDF · 124 KB

↓ Download
□

Section 3

Children & Teens

Download the intake form that matches your child's age. All other forms apply to all minors. The parent or guardian must complete the Consent to Treat a Minor form.

Child Intake Form

PDF · 294 KB · For children under 12

↓ Download

Teen Intake Form (Ages 12–17)

PDF · 296 KB

↓ Download

Client Informed Consent

PDF · 147 KB

↓ Download

Consent to Treat a Minor

PDF · 154 KB · Completed by parent/guardian

↓ Download

Children & Adolescents Telehealth Consent

PDF · 136 KB

↓ Download

CAMFT Notice of Privacy Practices

PDF · 43 KB

↓ Download

CAMFT Acknowledgment of Receipt of Privacy Practices

PDF · 85 KB

↓ Download

Covid-19 Release of Liability

PDF · 124 KB

↓ Download

If any form is inaccessible to you or your child, please let your therapist know — they will make accommodations.

Formularios de Admisión en Español

Estos formularios deben completarse y devolverse a su terapeuta antes de poder comenzar su primera sesión. Si esta tarea no es accesible para usted, por favor infórmeselo a su terapeuta para que pueda hacer una adaptación.

Cuestionario de Admisión de Adultos / Adult Intake

DOCX · 126 KB

↓ Download

Consentimiento informado del paciente / Informed Consent

DOCX · 226 KB

↓ Download

Cuestionario de admisión de parejas / Couples Intake

DOCX · 248 KB

↓ Download

Cuestionario de admisión de niños / Child Intake

DOCX · 264 KB

↓ Download

Consentimiento de telesalud / Telehealth Consent

DOCX · 26 KB

↓ Download

Consentimiento para tratar a un menor / Consent to Treat a Minor

DOC · 172 KB

↓ Download

Divulgación de información / Release of Information

DOC · 170 KB

↓ Download

CAMFT Prácticas de privacidad / HIPAA Privacy Notice

PDF · 27 KB

↓ Download

Covid-19 Liberación de responsabilidad / Release of Liability

DOCX · 16 KB

↓ Download

Formulario de consentimiento pro bono / Pro Bono Release

PDF · 222 KB

↓ Download
□

Section 5

Additional Forms

These forms are used as needed — your therapist will let you know if any apply to your situation.

Release of Information

PDF · 59 KB

↓ Download

Pro Bono Agreement

PDF · 90 KB

↓ Download

Walk & Talk Release Form

PDF · 103 KB

↓ Download

Therapy Never Includes Sexual Behavior

PDF · 1.6 MB

↓ Download
Hours by Appointment
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