Forms

On this page you’ll find the forms needed to begin therapy with Roya Dedeaux.

If you are an in-person client, please print these forms, fill them out and bring them to our first session.

If you are a distant-client, please print these forms, fill them out, and send a scan or photo to royadedeaux@gmail.com with “INTAKE FORMS” as part of the subject line.

Intake form

Limits of Confidentiality

Consent to therapy

Consent to Treat a Minor (only if client is under 18)

Telehealth Consent Form (only if you are doing distance-counseling such as video chat or phone)

Confidential Info release (if needed to discuss treatment with another therapist, psychiatrist, doctor, etc.)