Contact and New Client Forms

Psychotherapy Santa Cruz,
Licia Ginne, Psy.D., MFT
Day and Evening Appointments Available

 

FORMS FOR NEW CLIENTS – The forms can be filled out online,  printed and brought to your first appointment. Please do not email me them to me, they contain personal information that is not safe for email. Filling them out in advance allows us to spend more time together in the first appointment instead of taking the time at our meeting to fill them out. Please fill out the individual or couple information and the informed consent form.

Forms:
(click to download)

Individual Information
Couple-Information
Informed_Consent
Credit Card Monthly Pay
authorization to exchange confidential information

Note: If you have trouble opening or saving the form try another Web browser (like Internet Explorer). Right click the file link, choose “Save Link As”, and save to your computer. You’ll be able to open the file with your PDF file viewer (such as Adobe Acrobat Reader).

Please call or email with any questions you have about working with me or making an appointment. I encourage anyone looking for a therapist to call and spend a few minutes talking with the therapist in advance to see if seems like a good match.

My office is located in Capitola on Bay Ave across the street from Nob Hill Market. There is free parking in the lot and an overflow lot in-between my building and the Capitola Post Office. I look forward to our working together and please remember to fill out my forms in advance and bring them with you.

 

LICIA GINNE, Psy.D.,MFT 21421

Mailing Address:
P.O. Box 702
Capitola, CA 95010-0702

Office:
820 Bay Ave., Suite 205
Capitola, CA 95010
831.471.8647
310.828.1256

Email: DrGinne@gmail.com