Contact, Forms, and Payment

Contact

Please contact me by phone 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. This gives you an opportunity to ask questions about how they work, experience with your issues and financial arrangements.

My office is located in Capitola on Bay Ave across the street from Nob Hill Market. There is free parking in the lot and 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
Address:
P.O. Box 181
Capitola, CA 95010-0702

[email protected]

Forms

To mail forms to me please use my PO Box:
Licia Ginne
PO Box 181
Capitola, Ca 95010

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.  Thank you.

If you prefer I can send by regular mail or email the forms to you, let me know.

(click to download)

Individual Information
Couple Information
Informed Consent
monthly credit card payment authorization
single credit card payment
authorization to exchange confidential information

Payment

Online you can make a credit card payment or you can pay through Zelle.

To make a payment by credit card, please click the payment button below. If you have provided your email you should receive a receipt, if not let me know. 

If you get an AVS mismatch error, this means Address Verification Settings. Please check to make sure your address and/or zip code are  matching the banks information that has issued your credit card.  

Please contact me if you are having issues with the credit card system. 

Zelle can be used for payment.  Please contact me for my account information. 

LICIA GINNE, Psy.D. MFT

LICIA GINNE, Psy.D., MFT 21421
P.O. Box 181
Capitola, CA 95010
831 471-8647