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Jean L. Mirando, LMFT
Phone: (925) 494-0964
Telehealth Video Sessions
jeanmirando.com
FORMS -
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If you prefer to fill out the paperwork at home and bring it with you to your first session, please download 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 download or print the paperwork, please arrive 15 minutes prior to the first session to complete the paperwork in the waiting room.
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.


