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Forms for Couples Therapy

Counseling West
4419 Van Nuys Blvd., Suite 310
Sherman Oaks, CA 91403

(818) 990-9898  

Fax: 818 783 2243
Email: info@counselingwest.com
Your communication is private
and confidential.
Hours: Mon- Sat, 9am to 9pm

For Training Program inquires
Email: martha@counselingwest.com

We are conveniently located in
Sherman Oaks, close to the 101
and 405 freeways.


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Forms for Couples Therapy

We'd like to spend your appointment time getting to know you, not having you filling out paperwork.  For that reason, we ask that you please complete the following forms prior to your arrival.  If you are unable to do so, please arrive 15 minutes prior to your appointment, and advise your counselor so they may have the forms ready for you to fill out in our waiting room.

Couples Intake Form (pdf)
Consent to Therapy (pdf) Please complete one for each person
Consent to TeleMedicine (pdf) Please complete one for each person
HIPPA Notice (pdf)
HIPPA Release (pdf)
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Counseling West is 20 miles or 30 minutes from the following communities: Bel Air, Beverly Hills, Brentwood, Burbank, Calabasas, Canoga Park, Chatsworth, Encino, Granada Hills, Hollywood, North Hills, North Hollywood, Northridge, Panorama City, Reseda, San Fernando Valley, Sherman Oaks, Studio City, Sun Valley, Tarzana, Toluca Lake, Topanga Canyon, Valley Village, Van Nuys, West Hills, West Los Angeles, Westlake Village, Westwood, Woodland Hills