Please contact Elizabeth Kovacevich with any questions or to schedule an appointment: (831) 425-3456 (direct and confidential line)

Confidentiality Form PDF

Please click on the image to download forms

If you would like to come in for a therapy session, please fill out Express Form below to start the process.

In order to facilitate your in-therapy appointment, please download the confidentiality pdf  and fill it out prior to your appointment then bring it with you to your meeting.
Please print in clear legible handwriting.
Please be assured that we do not share or sell personal information about you except when we have your permission.

Express Intake Form

Please fill out this form as thoroughly as possible. Please add anything you think is important. All information contained in these pages is completely confidential.

Personal Information

Subject: [Client Intake Form - Expanded]

Date of Birth

Is it okay to Leave a Message?
YesNo

Best Way to Contact You?

 
If you are under the age of 18
 


 


 
Person to contact in an emergency?


Appointment Information

 
What would you like to talk about in your appointment?

 
Level of Stress?
LowAverageHigh

Are you interested in receiving notifications of classes, support groups, lectures, tele seminars?
YesNo
 


 

I understand that I am responsible for payment, keeping all scheduled sessions and that there is a 24 hour cancellation policy.

I Agree