Marian's Forms

Please print the appropriate forms below, complete them and bring to your first appointment.

(Your therapist will send a confirmation email to you identifying which forms you will need to bring.)

Disclosure Statement

HIPPA Authorization

Credit Card Authorization

PHI Consent to Electronic Communication

Authorization to Release Information

Waiver of HIPPA

Adult Intake Form

Minor Child Intake Form

Consent to Record

Adolescent Intake Form

MA, LPC, CHT, LMFTC

MA, LMFT, LPC, NCC

8774 YATES DRIVE, STE. 135

WESTMINSTER, CO 80031

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