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.

​

Intake Information

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. 

Informed Consent for Treatment

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.

FEES are listed in the form: Informed Consent for Child Therapy. Due to the pandemic which is causing hardship for so many, I am offering a few spots for clients who need reduced fees. Please discuss this with me if you feel your family qualifies for reduced fees. 

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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