Piper Walsh, Ph.D. Clinical Psychologist
Call Now (949) 370-4726
Therapy for Children, Adolescents, Adults in South Orange County
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Documents
Please fill out the documents below that are consistent to the type of counseling and patient.
Please download and print the appropriate forms. Post completion, please scan and email to
drpiperwalsh@gmail.com
.
Individual Adult Counseling Paperwork
Contract
Health Inventory
Limitations on Confidentiality in Couple or Family Therapy
Mood Questionnaire
Patient Information Sheet
Consent Telepsychology
Adults over 65
Contract
Health Inventory
Limitations on Confidentiality in Couple or Family Therapy
Mood Questionnaire
Patient Information Sheet
Consent Telepsychology
Medicare Opt Out
Couples Paperwork
Contract
Health Inventory
Limitations on Confidentiality in Couple or Family Therapy
Mood Questionnaire
Patient Information Sheet
Consent Telepsychology
Paperwork for Parents with Children UNDER 12 Getting Counseling
Authorization for Minor Child
Contract
Health Inventory
Limitations on Confidentiality in Couple or Family Therapy
Patient Information Sheet
Consent Telepsychology
Paperwork for Children Between 12-17 Getting Counseling
These Forms Are for the Child 12-17 to Fill Out
Health Inventory
Limitations on Confidentiality in Couple or Family Therapy
Mood Questionnaire
These Forms Are for the Parent of the Child 12-17
Authorization for Minor Child (1)
Contract
Health Inventory
Limitations on Confidentiality in Couple or Family Therapy
Patient Information Sheet
Consent Telepsychology