Patty Emberley
(831) 331-9140
303 Potrero St. Suite 5C
Santa Cruz, CA 95060
patty@emberleycounseling.com
HELPFUL FORMS

If you're a new client, please complete the following forms and bring them to your first session. If you have any questions or concerns please talk with Patty before your first appointment or during it.

  • Client Intake Form
  • New Client Questionaire
  • Informed Consent
  • HIPPA Notice of Privacy Practices

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form:

  • Consent to Release Information Form

 


Client Intake Form Contact Information
New Client Questionaire
Consent to Release Information Form
HIPPA Notice of Privacy Practices
Informed Consent

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