Resources for Healthy Sexuality In Southern California

Sexual Health Through Education and Skill Building

Intake Forms

Before your first appointment, access these forms and bring them to your first appointment:

(1) Contact Information and Insurance Information;

(2) Billing Authorization and Cancellation Policy;

(3) Sibylle Georgianna, Ph.D.: Individual’s/Couple’s Consent to Treatment;

(4) Sibylle Georgianna, Ph.D.: Privacy and Social Media Policy;

(5) Male Physical History Form;

(6) Female Physical History Form;

(7) Assess Background History;

(8) Assess Sexual History;

(9) Intake Forms for a Minor.

 

Miscellaneous:

(1) Authorization to talk to another provider;

(2) Participation in workshops;

(3) Weekly log.