Adrienne L. Levy Therapy for Adolescents, Adults, Couples, and Families

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Adrienne Levy
(760) 720-5320
2551 State Street, Suite 226
Carlsbad 92008
alevymft@gmail.com
Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Informed Consent to Therapy
  • HIPAA Client Rights

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form


 

Client Psychotherapy Intake Form  
Authorization to Disclose Information Form  
Informed Consent  
HIPAA Client Rights  

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