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Click on each PDF file below to open and download the desired New Patient form.

Your privacy is important to us.

 

 AW Informed Consent 
for Assessment 

 

 Authorization to Disclose  
Protected Info 

 

 Consent Forms 

 

 Credit Card Processing 
Info Sheet 

 

 Client Information 
Paperwork 

Please note: I am an out-of-network provider with insurance companies.

I can provide you with a medical receipt for you to submit to your insurance company for reimbursement.

Allison Waite, MFT  /  1001 Dove Street, Suite 260, Newport Beach, CA 92660  /  949.630.5592

​© 2022 Allison Waite Therapeutic Services. Original site design by Life in Ceremony.

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