Documents

How to Return Documents to me:

Please download each form, print it, fill it out, and initial and sign where indicated.

Email: As noted in my Office Policies document, there are some risks to using email, and people using email should understand and accept those risks. My email is HIPAA compliant and offers end to end encryption:
andrea (at) somaticwise (dot) net
US Postal Mail: Andrea Bell, LCSW, SomaticWise, 512 Redondo Avenue, Suite A, Long Beach, CA, 90814.
Drop-Off: Through the mail slot in my front door. Please notify me if you’re going to drop off forms, so that I can be on the lookout for them!
Fax: just ask me and we’ll make arrangements.

Waiting Room: In person appointments may come in 15 minutes early and fill them out in the waiting room, if they prefer. (This is unavailable during COVID-19 pandemic and shelter at home orders).

 

Here are the documents:

Intake Forms: Before our first appointment, or to re-start therapy after a break, new clients need to download and fill out the following intake forms: 

Initial Overview and Contemplation_compressed

Andrea’s Office Policies 2021

SE Informed Consent PDF_compressed

Updated Notice of Privacy Practices_compressed

SW TeleHealth consent form

Please note: I also need a copy of the client’s driver’s license or other state-issued ID card, to verify identity.  

 

Other Miscellaneous Forms: 

EMDR: These two forms are required for persons wanting to include EMDR in their treatment:

SomaticWise EMDR consent form

Dissociative Experiences Scale-ii

Contact Info: How to (and how not to) be in touch with me.

Client Contact Information

 

Safety plan for people experiencing suicidal thoughts, intent and or plan: Brown_StanleySafetyPlanTemplate

Information release form (gives me permission to communicate with other professionals, loved ones, or others): Authorization To Exchange Confidential Information

The following document is only required for COUPLES or FAMILY THERAPY:
SomaticWise No Secrets Couple Family_compressed

Form for SE Student Sessions: SE session consent form

“Relentless, stubborn optimism.”

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Nature and therapy podcast!

Hi everyone, I’m on a podcast about Ecotherapy–please give it a listen! This is a wonderful podcast called “Eat …

Under Construction! Thanks for your patience!

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