Anxiety & Depression Therapy - Orange County CA - Liz Birch, LMFT
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    Intake - Adolescent (ages 12 - 17)
    Please complete this form prior to our first session.  All information is protected by confidentiality. 
    ** This is a Secure form.  All information sent will be encrypted.  








    Behaviors / Symptoms



    Education

    Medical


    Social / Cultural

    Legal



    Thank you for taking the time to complete this form.   Your responses will help me better serve your youth.    ~  Liz Birch, LMFT
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  • Home
  • About Me
  • Talk Therapy
  • Hypnotherapy
  • Fees, Insurance, Directions
  • Why Do You Want Therapy?
  • Blog
  • Important Forms
  • Podcasts
  • Confidentiality