FORMS*

 

 

*Available online too; please email us to access online if you didn't receive it prior to your intake

Please fill out the form that applies to you or your child's age and bring them to your first appointment, and any court documents (if applicable).  If you have a custody agreement, we must have a copy of this on file prior to seeing your child. 

If you are participating in group therapy, please view and sign this consent form for services:

If you would like your therapist to coordinate care with another provider at any point during therapy (i.e,, psychiatrist, physician, other family member, step-parent, etc.), complete this form to authorize release of psychotherapy information:

 


Confidentiality & Privacy Policy

The law protects the relationship between a client and a therapist, and information cannot be disclosed without written permission.

Exceptions include:

  • Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.

  • If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.

  • If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.

Houston (West Memorial) Location: 

14780 Memorial Drive Suite 202

 Houston, Texas 77079

  • Facebook Social Icon
  • Pinterest Social Icon
  • YouTube Social  Icon

The Woodlands/Spring Location:

1544 Sawdust Rd. Suite 260

 The Woodlands, Texas, 77380

Email: admin@juliascounseling.com
Tel:  832-303-8933

Fax:  832-383-3817

© 2015 by Julia's Counseling & Play Therapy Group, PLLC