Our time together is precious
Please complete and submit this form at least one day in advance of our first session. This will let me look over your history, current situation, and goals for counseling before we sit down together, so we can make the best use of our time in the session. Clicking below will take you to a secure site where the information you enter will be encrypted and accessible only by me. Please complete a separate set of forms for each adolescent who will be receiving counseling. (If you run into problems completing these on a tablet or phone, please try completing them on your computer.)
- Client Information – To Be Completed by Adolescent
- Client Information – To Be Completed by Parent/Guardian of Adolescent
If you are not able to enter your information online, please let me know whether you would rather
- receive an email with copies of the forms to print, complete, and bring in, or
- complete the forms in the waiting room before your session (please allow 20-30 minutes).
Please call (714) 584-4447 for a free 20-minute phone or office consultation about how this type of therapy could be helpful in your particular situation.
Relationship Therapy by Betsy Walli, LMFT – (310) 504-1893
2309 PCH, Suite 208, Hermosa Beach, CA 90254
13001 Seal Beach Blvd., Suite 360, Seal Beach, CA 90740