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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-Child/Teen

    The following forms are here to help you get started. Please download and look them over, so that your first appointment will be productive.

    • Teen and Child Infomation Form
    • Teen and Child Informed Consent
    • Teen and Child Developmental History
    • Teen Symptoms Questionnaire
    • Female Hormone Questionnaire
    • Notice of Privacy Practices
    • Private Practice Policies
    • TEMPORARY PARKING PASS

    If you think that there is a possibility that your  child or teen suffers from anxiety or depression, please him/her fill out these forms and return them to me at his/her appointment.

    • Beck’s Depression Scale
    • DASS-42

    If there is a teacher, physician, psychiatrist, former therapist or anyone else that might be helpful in your child/teen’s assessment or treatment, please fill out this form for each individual to and return it to me.

    • Authorization to release confidential info from KJLMFT

    If there is an administrator, teacher, physician, psychiatrist, former therapist or anyone else that you would like me to be able to communicate with on behalf of your child’s/teen’s treatment, please fill out this form and return it to me.

    • Authorization to release confidential info to KJLMFT
    ENTER YOUR EMAIL HERE, AND I'LL SEND YOU PERIODIC TIPS, INFORMATION, AND REALLY COOL TOOLS.
    By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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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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