Dr. Jennifer Vanderburg, Psy.D
Thank You for your interest in working together. For your convenience, I have provided my practice paperwork that you may print out, complete and bring to your first appointment. We will have time during our first meeting to review these forms and answer any questions you may have. You are welcome to highlight sections you would like to talk about, or to write notes for yourself in the margins. Please do not feel that you have to sign any of these documents before your questions have been answered.
If you would prefer to complete these forms in my office, please let me know, and plan on coming to your appointment a little earlier (10-15 minutes). I will have these forms available for you at my office.
These First Appointment Forms include the following documents:
1) Therapist-Client Agreement: includes informed consent for treatment, describes therapy, your rights as a client, and provides important information about confidentiality and insurance/fees.
2) Client Information Sheet: general information I need to bill your insurance company. If you plan to use your insurance benefits, please bring your health insurance card with you on your first visit.
3) Symptom Checklist: questionnaire that will give me a sense of your current concerns.
4) Credit Card Consent: authorization to charge your credit card if you will be using it for payment.
5) Notice of Privacy Practices: describes federal regulations about the use and disclosure of your health information. Federal law requires all health care professionals to provide this document.
Please feel free to call me if you have questions.
3551 Florista St., Suite 1D
Los Alamitos, CA 90720
My office is located approximately one mile Northeast of the 605/405 interchange. Florista St. is located between Los Alamitos Blvd. and Pine St. just one block North of Katella Ave. It is on the North side of the street. The building is handicap accessible. Parking is ample.