• WELCOME
  • ABOUT ME
  • MY PRACTICE
    • Individual Therapy
    • Couples Therapy
    • Sex Therapy
    • Compulsive Sexual Behavior
        and Addiction
    • Sexual Acting-Out (Adolescents)
  • LET'S GET STARTED
    • What to Expect
    • Rates and Insurance
    • Forms
  • CONTACT ME

 

 

 

 

If you are a new client, please print out and complete the applicable documents and bring them with you to our first appointment.

 

 

Individuals (Adults)

Client Intake Form
Acknowledgement of Receipt
Informed Consent (Adults)
Notice of Privacy Practices - Read Only
Emergency Procedures - Read Only

 

Individuals (Minors)

Client Intake
Acknowledgement of Receipt
Informed Consent (Minors)
Notice of Privacy Practices - Read Only
Emergency Procedures - Read Only

 

Couples

Client Intake
Acknowledgement of Receipt
Informed Consent (Couples)
No Secrets Policy
Notice of Privacy Practices - Read Only
Emergency Procedures - Read Only

 

Additional Information

Authorization to Release and Exchange Confidential Information

 

Dagmara Svetcov, LMFT   699 Peters Avenue, Suite A, Pleasanton CA 94566   P 925.575.8706 F 844.726.0543   Email