Abraham Aviles-Scott
Licensed Marriage & Family Therapist
If you're a new client, please complete the following 4 forms and bring them to your first therapy session.
Note: To download Adobe Acrobat Reader for free, click here.
Note: To download Adobe Acrobat Reader for free, click here.
1. Intake Questionnaire (complete, sign, and return)
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2. Informed Consent (complete, sign, and return)
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3. Acknowledgement of Receipt of Privacy Practices (complete, sign, and return)
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4. Notice of Privacy Practices (KEEP for your records)
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If you would like to have telehealth sessions (audio and video through a personal computer or mobile device), please read and sign this Informed Consent for Telehealth Services. I use VSee to provide telehealth; my waiting room URL is aavilesscott.vsee.me/u/tele. Instructions for using VSee on a computer internet browser are included below; a VSee Clinic mobile app is also available for iPad, iPhone, and Android (see this page for links).
5. Informed Consent for Telehealth
6. VSee Patient Manual
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If you want me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), please request and complete an Authorization for Use or Disclosure of Protected Health Information.
7. Authorization for Disclosure
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If you want to put a credit card on file for future charges, please complete this form. (I do not yet have a Spanish-language version of this form.)
8. Card on File Authorization
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