Please download, print and complete the first five forms and e-mail them to Bijan@BijanAmirshahi.com before our first meeting. The sixth form is for you to read and keep. If more than one person, please have a set completed for each. Thanks.
6- HIPPA Notice of Privacy Practices
7- Authorization to Release Confidential Information
8- Authorization to Exchange Confidential Information
Bijan Amirshahi Licensed Marriage and Family Therapist Lic. # 46183 Licensed Professional Clinical Counselor Lic. # 387 4000 Barranca Parkway, Suite 250 Irvine, CA 92604 Non-emergency Texts Only (949) 533-3177 bijan@bijanamirshahi.com www.bijanamirshahi.com
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