Resources for Healthy Sexuality In Southern California

Sexual Health Through Education and Skill Building

Get Started

I am here to help you. Select and complete the appropriate forms to get started on the journey.

1. An Intake Form must be completed by all clients. Please email the completed form to: sgeorgianna@gmail.com prior to our first session.

2. The HIPPAA and Social Media Policy that informs you about the confidentiality of your records, limits of confidentiality/mandated reporting requirements, and social media specifics.

3. The Individuals’ and Couple’s Consent form acknowledging that you understand professional policies with regards to our work. Please email the completed form to sgeorgianna@gmail.com prior to our first session.

4. The Adult Intake Form of your Female Physical History (form for women) or Male Physical History (form for men). Please email the completed form to sgeorgianna@gmail.com prior to our first session.

5. The Adult Intake form of your Learning History. Please email the completed form to sgeorgianna@gmail.com prior to our first session.

6. The Adult Intake form of your Sexual Evaluation (if applicable). Please email the completed form to sgeorgianna@gmail.com prior to our first session.

7. Review, initial, sign the Credit Card Agreement and fax the signed copy to my confidential fax number (949) 607 3545.

8. For treatment via phone, VSEE, FaceTime, or Skype: Review and sign the Office Policies Online Provision of Services and, sign it, and fax the signed copy to my confidential fax number (949) 607 3545.

9. Complete the Authorization for Your Providers to Talk if you want me to talk with your referring therapist or physician.

 

I am a Blue Shield of CA PPO provider. Review our insurance submission information.

Leave a Reply

Required fields are marked *.


Warning: in_array() expects parameter 2 to be array, string given in /home/thelea53/public_html/sexualhealthoc/wp-content/plugins/yikes-inc-easy-mailchimp-extender/public/classes/checkbox-integrations.php on line 118