REQUIRED INTAKE PAPERWORK
Please download and complete the appropriate paperwork and bring the completed forms with you to your scheduled appointment. All paperwork must be completed before the start of the session. If for some reason you are not able to complete the paperwork, or need assistance please let the administrative staff know before you arrive at your scheduled appointment time to ensure that adequate accommodations can be made to assist you.
Please note for adult and child/teen clients: Before your appointment is scheduled you will be asked to read the following documents and then contact the administrative staff to set up an appointment. All forms must be filled out and brought with you to your first scheduled appointment. The session will not begin until all forms are completed and given to the administrative staff before seeing your therapist.
Office Policies and Informed Consent
Notice of Privacy Practices
HIPAA Privacy Rule and Sharing Information Related to Mental Health
Receipt of Notice of Privacy Practices
Please note the following paperwork will also be required to be filled out before the start of your therapy session:
For child/teen clients (under age 18) please complete:
OFFICE ADDRESS & PHONE
Please note the address you will be coming to is:
3111 Los Feliz Blvd Suite #106
Los Angeles, CA 90039
You can park behind the building in the free (first come first serve) parking lot or in front of the building on the street (meter parking).
Upon entering the building enter suite #106. You will enter into a small waiting room where you can wait and I will come and get you at your appointment time.
Also-if you arrive early to your appointment and the door to #106 is locked, please wait in the Guest Lobby (near the entrance of the building) and I will come and get you at your appointment time.
Please note that sessions are scheduled by appointment only (no walk in’s). My administrative staff/assistant Melinda is in the office Monday, Wednesday, and Friday from approximately 9am-2pm to answer phone calls and handle scheduling. You can call 661-208-5099 during these scheduled times, leave a message and she will return your call within these hours to schedule appointments and answer any questions you may have.
Also, please note that phone calls are usually returned within a 24 -48 hour period. If for some reason you have not received a call back within this time frame, please call again and leave another message, as I do my best to handle calls on the days Melinda is not in the office, although I am typically in session from 9-6 and this disallows me to get back to people within normal business hours and I may wait until the following day to have Melinda return your call if I have not been able to get to it. Thank you for your understanding regarding this matter.
INSURANCE BENEFITS & ELIGIBILITY
Please note: As a courtesy I will bill your insurance for you, however, you are responsible for understanding your insurance benefits and for payment of the service if your insurance does not agree to coverage. Therefore, it will behoove you to contact your insurance before coming to your appointment and complete the Insurance Verification form, found above.
Please note that your copay is expected at the time of service and I accept cash only.
I look forward to working with you. If you have any questions or concerns please feel free to contact me by phone.
Respectfully, Shannon Lee, LMFT
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