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(925) 658-0030 | Walnut Creek, CA | Dr.Grevin@eastbaypsychotherapyservices.com

Francine Grevin, Psy.D.

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Client Forms

All clients: The Office Policy, HIPAA, Billing Practices and Media Policy Forms are required for ALL clients of any age.

The appropriate history form(s) (Adult, Child, Teen Questionnaire) should be selected according to the client’s age.

Treatment of all children and teens under the age of 18 must also include the Consent for Treatment of a Minor form. The latter form requires the signature of ALL parents or legal guardians, as do the Office Policy and HIPAA forms.

For all teens: In addition to the the Teen Questionnaire (to be filled out by the teen), a Child History Form should also be completed by a guardian or other appropriate adult.

The Release of Information Form permits contact between myself and any previous, concurrent or referring clinician(s) as needed and mutually agreed upon.

 

Office Policies

Billing Practices

HIPPA Notice of Privacy Policies

Media Policy

Child History

Teen Questionnaire

Adult History Form

Consent for Treatment of a Minor

Release/Exchange of Information

Mailing Address:
1547 Palos Verdes Mail Suite # 409
Walnut Creek, CA 94597

(925) 658-0030
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