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    395 Taylor Blvd, Suite 220 | Pleasant Hill, CA 94523
    925-322-1681 | katherine@timetothrivetherapy.com

  • Time to Thrive Therapy

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        • Counseling for Depression
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        • Women’s Divorce Support Circle
        • Teen Life Support Group
        • Kick-Butt Strategies for Handling Life for Teen Young Women
        • Support and Education Group for MFT and LPC Trainees
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    New Client Documents-Adult

    The following forms are here to help you get started. Please download, print, read,sign, and bring the following forms to your first appointment so that we can get right to work.

    • Client Information Form
    • Client Informed Consent
    • Client Symptom Form-Men
    • Client Symptom Form-Women
    • Notice of Privacy Practices
    • Depression Anxiety Stress Scale
    • Anxiety and Depression Questionnaire
    • Private Practice Policies
    • TEMPORARY PARKING PASS

    If there is a doctor, previous therapist, or someone else that might have information helpful for your assessment and/or treatment, please fill out this form and return it to me to allow us to confer.

    • Authorization to release confidential info to KJLMFT

    If you would like for me to communicate with a doctor, therapist, or anyone else with regard to your assessment or treatment, please fill out this form and return it to me.

    • Authorization to release confidential info from KJLMFT

     

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    Katherine Jewett, MA LMFT #83521
    395 Taylor Blvd, Suite 220
    Pleasant Hill, CA 94523

    925-322-1681
    katherine@timetothrivetherapy.com

    Katherine Jewett
    katherine@timetothrivetherapy.com | 925-322-1681

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