Kristina Schasker, M.A., MFT Specializing in Couples, Individuals and Adolescents

  • Home
  • Services Provided
  • Common Questions
  • Rates & Insurance
  • Appointment Request
  • Helpful Forms
  • Links & Resources
  • Contact Me
  • Make a Payment
  • About Me
Kristina Schasker, M.A., MFT
(925) 567-6301
kristina@kristinaschasker.com
Helpful Forms

If you're a new client, please complete the following forms and bring them to the initial consultation:

  • Consent to Psychotherapy
  • Client Psychotherapy Intake

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete one of these forms to authorize release of psychotherapy information:

  • Release of Information
  • Release of Information for a Minor

If the client is less than 18 years old, please bring the following forms completed and signed to the initial consultation:

  • Permission to Treat a Minor
  • Adolescent Concerns Inventory

Consent to Psychotherapy client understanding and agreement to terms and policies
Release of Information only necessary to consult with other professionals regarding treatment and disgnosis
Permission to Treat a Minor signed by the parent or legal guardian when the client is less than 18 years old
Adolescent Concerns Inventory filled out by the adolescent
Release of Information for a Minor only necessary to consult with other professionals regarding treatment and disgnosis for a minor
Client Intake one filled out by each client participating

Note: To download Adobe Acrobat Reader for free, click here.


©2010 by TherapySites.com. All rights reserved.
5509d11766ac0883ad22aa86b543c28e