Forms
All new clients should complete the necessary forms and return them before your first session.
Each member of couples or family sessions should complete their own set of forms.
Note: These fillable forms work best in Acrobat. To download Adobe Acrobat Reader for
free, click here.
Telehealth clients (audio and/or video through a personal computer or mobile device) should
complete this Informed Consent for Telehealth Services. I provide telehealth with Doxy.me video
conferencing. Visit https://doxy.me/ for instructions or more information.
After completed, submit by clicking the link below
If you would like to put a credit card on file for future charges, please complete and return this
form. I will email a Square receipt at the time of each charge.
If you would like me to coordinate care with another provider (for example, your psychiatrist,
primary care physician, etc.), please complete an Authorization for Use or Disclosure of
Protected Health Information.
Trishka L. Lampkin, LMFT #129849
Concord Business License: #5027571