Please download, print and complete the first four forms and bring to the first meeting. The fifth form is for you to read and keep. If more than one person, please have a set completed for each. In case of couples and families please also complete the sixth form and bring to the first meeting. In case a person under the age of 18 is attending the meeting complete and bring the seventh form to the first meeting. Thanks.
HIPPA Notice of Privacy Practices
Authorization to Release Confidential Information
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 Telephone/Text (949) 533-3177 bijan@bijanamirshahi.com www.bijanamirshahi.com
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