Forms Not Logged In

We have provided these forms to all of our clients, to help them with their treatments in and out of the office. Click on any of the form links to download them to your computer.

All forms are printed in Adobe Acrobat (PDF) format. Visit the Adobe website to download a free version of Acrobat Reader if needed.

Psychotherapy Forms

Intake Packet for Psychotherapy Patients | Log In To Download

The following paperwork is required from you prior to your first appointment. The document is 15 pages long.

It includes:

  1. Personal History form
  2. Treatment and Office Policy Information form
  3. HIPPA (Health Insurance Portability & Accountability Act) form

Please print out the entire document, fill it in completely and fax (800-313-7756), or mail (Jane Bryson Ph.D., 3201 Wilshire Blvd., Suite 209; Santa Monica, CA 90403) before your first appointment. You may send the entire document, however, only the Personal History Form (pages 1-9), and the signed consent forms on pages 12 and 15 need to be returned. Be sure to keep copies of the Treatment and Office Policy form (pages 10-11) and the HIPPA form (pages 13-14) for your records.

Please note the Personal Information form is quite thorough and will take time to complete. It provides very important information that will help us understand your history and the issues on which you wish to work. If you have any trouble understanding the paperwork, give us a call and we will go over it together.

If you are simply unable to print or complete the paperwork in advance, call us, come in 45 minutes prior to your appointment, and we will have it available for you in the waiting room.

Thought Record for Psychotherapy Patients | Log In To Download

Note: use a legal size sheet of paper to print out the following document

Activity Chart for Psychotherapy Patients | Log In To Download

Note: use a legal size sheet of paper to print out the following document

Depression Inventory | Log In To Download

Download and print the document. Fill it out by hand and then fax (800-313-7756) or email (jb@jbrysonphd.com) the completed inventory to me, or bring it with you to your next appointment.

Anxiety Inventory | Log In To Download

Download and print the document. Fill it out by hand and then fax (800-313-7756) or email (jb@jbrysonphd.com) the completed inventory to me, or bring it with you to your next appointment.

Family Law Services Forms

Family Therapy Intake Form | Log In To Download

Family background and current situation form due before initial appointment

Treatment and Office Policy Information for Family Therapy | Log In To Download

Informed consent form for treatment

HIPPA Form | Log In To Download

Documentation of legal guidelines concerning professional records and confidentiality.

Stipulation for Counseling | Log In To Download

Sample stipulation for court-ordered counseling

Authorization for Release Medical/Confidential Information | Log In To Download

Release of Confidential Information form to permit Dr. Bryson to exchange information with another professional or the Court

Family Law Related Psychotherapy Agreement | Log In To Download

Informed consent agreement for psychotherapy

Coparent Counseling Agreement | Log In To Download

Informed consent agreement for coparent counseling

Consent for Confidential Mediation | Log In To Download

Informed Consent to engage in confidential child custody mediation

Consent for Recommending / Non-Confidential Mediation | Log In To Download

Informed consent to engage in Recommending/Non-confidential mediation

Consent for Collaborative Law | Log In To Download

Informed consent for Collaborative Law Family Coach or Child Specialist

Parenting Coordination / Special Master Forms

Special Master Stipulation Sample | Log In To Download

Case Management Order | Log In To Download

Child Custody Evaluation Forms

Child Custody Evaluation Questionnaire | Log In To Download

Custody Evaluation Procedures for Attorney | Log In To Download

Custody Evaluation Procedures for Parents | Log In To Download

Custody Evaluation Stipulation | Log In To Download

Custody Evaluation Office Policy Information and Informed Consent | Log In To Download

Custody Evaluation Collateral Contact List | Log In To Download

Custody Evaluation Release of Information Form | Log In To Download

Please don’t hesitate to contact us if you have any questions about our forms and patient worksheets.