+(408) 763-9546 cherissegage@breatheagaintherapy.com
Wed evenings 530p - 730p Sat 2p - 5p un 11a - 4P

Forms

Please download and complete prior to your first session.This is highly recommended. 

 We will go over forms together during your first session.  The first session will be a getting to know you time, that includes an assessment period of what you’d like to work on in therapy. 

Having the forms completed helps us to dive right in with the session.

Specifically, I will use the information provided on the forms to learn more about your past history, stressors, goals in therapy, and current situations requiring addressing.

  • Informed Consent For Treatment
  • Intake Form
  • HIPAA
  • Release of Information
  • Sexual Health Form
  • How Are You Feeling
  • Who’s Your Support System