Client Forms and Other Information

Health Insurance Coverage

Dr. Valdez is not an in-network provider for any insurance company. Many of her clients are insured and have out-of-network benefits. To find out whether or to what extent your insurance may cover your meetings, call your insurance company and ask, “What level of coverage do I have for out-patient mental health services with a PhD-level licensed professional counselor who is outside your provider network?” This is worded in language that your insurance company will understand so that they can give you accurate information.

When you call your insurer, Dr. Valdez recommends you write down for your records the date of the call, the phone number you called, the name of the person with whom you spoke, and what that person told you about your coverage.

Disclosure/Informed Consent

The Disclosure Statement and Informed Consent gives you an overview about the therapist, counseling in general and business related information in order for you to make an informed decision about going forward with counseling. Please download and print and bring with you to the first session.

Disclosure Statement

Informed Consent

Child/Adult Background

Questions asked in the background form allow for a better understanding of your situation or health problem so that Dr. Valdez may help you in the most efficient and effective way. Please download, print and answer all questions as fully as needed. Please bring with you to the first session.

Child Background

Adult Background

HIPPA Information

The HIPPA information covers how your medical records are handled by all health care providers. Your records are private unless you want the information released and only then when you give written permission. Please download, print, read through the information and bring with you to the first session.

HIPPA Information

HIPPA Confirmation

Other Forms

Release of Information

Counseling, Biofeedback & Clinical Hypnosis

counselingCounseling is a relationship designed to help you be good at being yourself.

Learn more about Counseling

counselingBiofeedback therapy can improve many distressing symptoms like anxiety, headaches, hypertension and more.

Learn more about Biofeedback

counselingClinical hypnosis is often misunderstood but is an extremely helpful experience for stress management, performance enhancement and more.

Learn more about Clinical Hypnosis