EMPOWER TCT LLC
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FORMS

SUBMITTING FORMS

Please fill out the forms that you have been asked to fill out (some may be below) and then click on this link to upload the forms and send them securely back to us.

NEW CLIENTS

Please print and complete the following forms and bring them with you to your first therapy session:
  • Patient Intake Packet
  • Screenings​​
  • Telehealth Psychotherapy Consent

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
  • Release of Information Form
​
Note: To download Adobe Acrobat Reader for free, click here.

​We are committed to your privacy. 
Do not include confidential or private information regarding your health condition in any digital forms found on this website.

HOLMAN CLIENT FORMS

  • Coordination of Care Form
  • ​Holman Referral Intake Additions

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Contact
P: 805-266-3231
F: 805-262-6275
empowertct@gmail.com
© COPYRIGHT 2022. ALL RIGHTS RESERVED.
Service Areas in California: Santa Maria, Pismo Beach, San Luis Obispo, Los Angeles
  • Home
  • Services
    • Training
    • Consulting
    • Therapy
  • About
    • Media Mentions
    • FAQs
  • Contact Us
  • Resources & Tips
    • Resources
    • Tips