Kristin's Comfy Couch Family Counseling Kristin Perry, LMFT
Kristin's Comfy Couch Family CounselingKristin Perry, LMFT

Admissions and Assessment Forms

Admissions Forms: It is helpful if you print and complete these forms in advance and bring them with you to your first session. Thank You!

Informed Consent Form- Authorization to Treat
A document describing counseling process, fees, procedures etc. Requires client signature. Mandatory form.
KCC Informed Consent.pdf
Adobe Acrobat document [232.5 KB]
Adult and Teen Self Assessment Form & Client History
Please fill out before first session. Feel free to leave sections blank or write in N/A if the question does not apply to you or you are uncomfortable answering.
KCC+Assessment+forms.pdf
Adobe Acrobat document [411.3 KB]
Child's Intake Assessment Form
Complete this form insteas of the adult and teen assessment form for children under the age of twelve.
KCC CHILD INTAKE ASSESSMENT FORM.pdf
Adobe Acrobat document [123.4 KB]
Kristin's Comfy Couch Notice of Privacy Policies
Informational Only- HIPPA Compliant Notice of Privacy Policies for Consumers
KCC+NPP+HIPPA.pdf
Adobe Acrobat document [55.6 KB]
Authorization for Release of Information
Complete this form if communication with a school, doctor, court, or other outside organization or person is needed to help you. Please complete a separate form for each entity.
KCC+Authorization_to_disclose_English.pd[...]
Adobe Acrobat document [58.3 KB]
Clerical authorization to use or disclose protected health information
Release form describing administrative and clerical management issues related to your counseling information. Requires client signature.
KCC+clerical+AUTHORIZATION+TO+USE+OR+DIS[...]
Adobe Acrobat document [37.2 KB]
Electronic communication disclosure form
Describes the limits to confidentiality presented by electronic communication- or e-mail and establishes practice's policies. Requires client signature, or decline.
kcc+e-mail+disclosure+form.pdf
Adobe Acrobat document [87.6 KB]
Print Print | Sitemap Recommend this page Recommend this page
© kristin's comfy couch

Find your balance with Kristin Perry, MFT

BBS Registration #48092

Questions?

 

I am not currently able to accept new clients. If you are a former or current client, and need to reach me, it is easier for me to respond to texts or emails at this time and schedule phone contact:

(619) 368-9339

 

kristinscomfycouch@

gmail.com



Emergency Information

Please call 911 

or

24 Hour

Access and Crisis Line: 

800-479-3339

or

The National Suicide Prevention Hotline

800-273-8255

in the event of an Emergency.



Questions?

Check out my FAQs for additional information and help.


 

Address and Phone

Kristin Perry, MFT

***************

Kristin's Comfy Couch

Family Counseling

2558 Roosevelt Street

Suite 201

Carlsbad, CA 92008

****************

Phone; 760-978-6071

 

To reach me, or schedule a time to talk, please text my cell phone number below, or e-mail me through the contact link or at the address below, it is difficult for me to talk on the phone, because I'm home with my very busy preschooler much of the time:

 

 

Text 619-368-9339

 

Fax: 858-860-5299

 

E-mail: kristinscomfycouch@gmail.com

 

For all Your Carlsbad Counseling Needs

 

"Specializing in Teens—

and Normal People Too!"