Child Comprehensive History

Please print and complete then bring this with you for the initial consultation.

insurance form

Please print and complete then bring this with you for the initial consultation.

consent for child

Please print and complete then bring this with you for the initial consultation.

APA_DSM5_Early-Development-and-Home-Background-Form-Parent-of-Child-Age-6-to-17

Please print and complete then bring this with you for the initial consultation.

notice of privacy practices

You are not required to print this document. However, please review it and make a note of any questions you may have so we can address them during the initial consultation.

(2) Office Policies and informed consent

You are not required to print this document. However please read it and make a note of any questions you may have so we can address them during the initial consultation.

Contact information

Janet Muehe-Hayward LCSW #23749

9067 Foothills Blvd. Suite #1

Roseville CA 95747

916-708-0927

lcsw.jmh@gmail.com

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