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. (If you run into problems completing this on a tablet or phone, please try completing it on your computer.)
- Client Information (Each adult should complete this separately)
- Client Information – Adolescent (Each adolescent should complete this separately.)
If you are not able to enter your information online, please let me know whether you would rather
- receive an email with a copy of the form to print, complete, and bring in, or
- complete the form 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 – (714) 584-4447
2309 PCH, Suite 208, Hermosa Beach, CA 90254
13001 Seal Beach Blvd., Suite 360, Seal Beach, CA 90740