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New Client Forms
For first appointment: New Client Intake Packet
Please bring these completed forms with you to your appointment, or ask your provider to send intake forms with electronic signature to do online.
Additional Forms: These forms may be used when prompted by your therapist.
Medical Information
Release of Information
Consent for Treatment
Please bring these completed forms with you to your appointment, or ask your provider to send intake forms with electronic signature to do online.
Additional Forms: These forms may be used when prompted by your therapist.
Medical Information
Release of Information
Consent for Treatment
For Providers Only
© Maple Counseling Center
2021 Sperry Ave. Suite 41
Ventura, CA 93003
(805) 669-8846 | Fax: (805) 272-9370
[email protected]
2021 Sperry Ave. Suite 41
Ventura, CA 93003
(805) 669-8846 | Fax: (805) 272-9370
[email protected]