social anxiety forms

Paperless Enrollment

In order to save time during your initial session with Anita Avedian, it is best to complete the paperless enrollment.

Please click here for PAPERLESS ENROLLMENT

Forms for adults and individual therapy. Please print and complete prior coming to session.

Intake
Notice of Privacy Practices
Receipt of Privacy Practices
Biographical Information

Forms for couples. Please print and complete prior coming to session.

Intake for Couples
Couples Information (Instructions, please print two of these forms. Each of you to complete and bring with you to the first session .) This is optional, however, recommended.

Notice of Privacy Practices
Receipt of Privacy Practices

Forms for minors. Parents/ Guardians to print and complete prior coming to session.

Intake
Agreement Regarding Minors
Treatment of Minor
Notice of Privacy Practices
Receipt of Privacy Practices

Forms for Social Anxiety Group

Intake for Social Anxiety
Notice of Privacy Practices
Receipt of Privacy Practices

Additional forms
If you would like for your therapist to speak with anyone about your progress or treatment, you will need to complete this form and either bring it with you, or fax it to (818) 783-2927.

Authorization For The Release Or Exchange Of Information

If you plan to use your insurance, please complete the following form and bring it with you to the session. Please remember that I am not on any panels which means I would be an “Out- of- network” Provider.

Insurance information