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.)
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).
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
Hope for Relationships 