Child Psychology Marin

Dr. Julie Maccarin, Ph.D., OT/L

(415) 785-3700

Child Therapy Forms

​Below you will find links to three forms. ​ Please download and complete the Intake Information form and the Informed Consent for Treatment form

and bring them with you to your first appointment. The HIPPA form is yours to keep.

Child Psychology Marin

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This form provides me with information about

your child and your concerns, which helps me be able to provide the best treatment for your child. 

This form provides information and requires your consent for therapy. It also includes information about the policies and fees of Child Psychology Marin. It is recommended that you keep a copy

of this document for your records.

I

This form provides information and consent for in-person therapy. 

This form provides information

and consent for using telehealth. 

Health Insurance Portability and Accountability Act

This form provides you with information about the privacy and security of your health information

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