Client Forms

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 and email them to *.

If you have questions please email ( ) or call our office at 480.285.7011

Forms for Therapy Appointments

Forms for Life Coaching Appointments


* Pursuant to the No Surprises Act which took effect January 1, 2022, you have the right to receive a “Good Faith Estimate” for the total expected cost of any non-emergency healthcare services, including psychotherapy services, before they begin. Although it is not possible to predict the number of sessions you will need before services are provided, you can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit