ALL CLIENTS must complete:
Children in therapy:
If parents of the minor are divorced I require both parents sign all the forms or provide a court custody order stating full custody.
Those paying with Credit Card or ATM:
Clients who would like Beliza Perdomo, LMFT to consult with another party must fill out:
ROI – Authorization to release confidential information
Supervised Therapeutic Visitation:
Supervised Visitation Agreement
2019 Rules of California Court (for client’s information only)
California Family Code Sec. 3200.5
FL324 – Supervised Visitation Provider (must request therapist signature)
ROI – Authorization to release information to the Superior Court