Getting started
New Client Questionnaire
Use this printable questionnaire to organize the information you would like to discuss during your consultation or intake.
Open questionnaireClient resources
Forms & Releases
Review practice information, prepare for your first appointment, or request a secure form. Please do not send sensitive health information through regular email.
Informed consent
Disclosure Statement & Agreement
Review qualifications, fees, confidentiality, communication, telehealth, somatic practices, and other service policies.
Review agreementPermission to coordinate care
Authorization to Release Information
A release is required before protected information can be shared with another provider or designated person. Request the secure, fillable form directly.
Request release formCost information
Good Faith Estimate
Clients who are uninsured or choosing not to use insurance may request a written estimate of expected charges for scheduled services.
Request an estimateAngelique M. Chess-Stiles is a California Registered Associate Marriage and Family Therapist, AMFT #150029, practicing under the clinical supervision of Shannon Vitro, LCSW #74811.