Forms

 

Jussi Light, M.A.   Licensed Marriage &Family Therapist

MFC#39617

In order to get started in therapy, it is necessary for you to complete my intake paperwork.  I do NOT accept these forms over email, so please download them, fill them out, and bring them to your first appointment. 

 

In addition to my forms, you may need information about insurance reimbursement—if so, click here. 

 

If you are unable to download my forms, it is likely that you do not have Adobe Reader installed on your computer—click here to download a free version.

 

NEW CLIENTS:  Choose ONLY one set of forms from the following three choices:

 

Family counseling           I am bringing in one or more children (17 or younger) for counseling.  Note—if divorced from the parent of any child coming for counseling, please ALSO download the “joint-legal custody” paperwork below.

Individual counseling     I am an adult (18 or older) coming for counseling by myself.

Couples counseling        I am coming in for couples, marital, or pre-marital counseling.

Other forms:

Joint Legal Custody     I am bringing a child for counseling and I am divorced from the child’s parent. 

Release of info               I wish to authorize Jussi Light to discuss my case with someone else.