Jean L. Mirando, LMFT

FORMS -

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Please fill out the paperwork, and mail it to the address given to you during your phone consultation Your Consent Forms must be received prior to your first session. Please print and fill out the Intake and Informed Consent Form below. This document contains information about my professional services and business polices. Please read each section, and initial and sign, indicating that you understand the policy. 

 

Please note on the forms my 72 hour cancelation policy. You may fill in the fee for the session on the forms, if you would like, that was discussed with you on the phone prior to your first session.

 

If you are not able to print the paperwork, please discuss this during your phone consultation.



Consent To Treat A Minor Form is the required authorization from parents, legal guardians, and conservators prior to providing psychotherapy to a minor. For divorced parents, consent is required from either, or both, based upon, and according to your legal custody agreement. Joint legal custody requires both parents' signatures, or each parent to sign their own form.