Thank you for requesting your appointment with Dr. Bettina, I look forward to meeting with you.
Prior to your appointment, please print and complete the required forms which fit your situation.
If you have questions please email (firstname.lastname@example.org) or call our office at 480.285.7011
Forms for Therapy Appointments
- New Patient Forms
- Agreement for Couples Therapy
- Agreement for Family Therapy
- Agreement for Additional Participants (if you would like someone to join your session)
- Notice of Privacy Practices (for informational purposes)
- Medicare Opt Out Private Contract (only for those covered by Medicare)
- Electronic Communication Policy (for informational purposes)
- Authorization to Release Records (if you would like me to communicate with someone on your behalf)
- Telepsychology Informed Consent