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Download Forms
New Client Information Form
Consent for Services
Informed consent is the communication between client and
provider that confirms that the client has made an informed
and voluntary choice to use mental health services.
For a child under the age of 18, the child’s legal
guardian (s) must sign for him/her.
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Fee Agreement
This form describes the fees for services provided by Dr.
Tanaka. Make
sure to read thoroughly and ask Dr. Tanaka if you have any
questions.
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Release of Information
All written or spoken materials from any and all sessions,
including psychological testing, will be considered
confidential. But if you need Dr. Tanaka to
communicate with an outside person (e.g., school personnel,
physician, psychiatrist), please review and sign this form
to authorize the communication. |
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