Therapy for Children, Youth and Parents

Therapy for Children, Youth and ParentsTherapy for Children, Youth and ParentsTherapy for Children, Youth and Parents
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About Dr. Dizon
Services
New Client Forms
Covid-19 Policies
Contact

Therapy for Children, Youth and Parents

Therapy for Children, Youth and ParentsTherapy for Children, Youth and ParentsTherapy for Children, Youth and Parents
Home
About Dr. Dizon
Services
New Client Forms
Covid-19 Policies
Contact
More
  • Home
  • About Dr. Dizon
  • Services
  • New Client Forms
  • Covid-19 Policies
  • Contact
  • Home
  • About Dr. Dizon
  • Services
  • New Client Forms
  • Covid-19 Policies
  • Contact

New Client Forms

Please download and complete the following forms and send them prior to your first appointment. 

You can fax them ahead of time to (888) 977-1372 or send via mail. 


For parents of children (11 and under): Please print all forms except the Adolescent background history.



For parents of adolescents (12 and over): Please print all forms (except the Child background history). 

Please note: Teens can complete pgs. 5-8  of the Adolescent Background History in private.


  I am happy to answer any questions you may have, and I look forward to our meeting. 


Office Policies and Informed Consent (pdf)Download
Telepsychology Informed Consent (pdf)Download
Therapy dog_Informed Consent (pdf)Download
Notice of Privacy Practices (pdf)Download
Child Background History (11 and under) (pdf)Download
Adolescent Background History (12 and over) (pdf)Download
Disclosure Notice- No Surprises Act (pdf)Download

Copyright © 2017 Marivic R. Dizon, PhD - All Rights Reserved.

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