Resources for Healthy Sexuality In Southern California

Sexual Health Through Education and Skill Building

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I am here to help you. Please call/text me at (917) 620 0481 or email me at sgeorgianna@gmail.com to schedule a visit. Please select and complete the appropriate forms prior to our visit*:

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 bring it to your session.

8. For treatment via phone, VSEE, FaceTime, or Skype: Review and sign the Office Policies Online Provision of Services and, sign it, and email it back to me prior to our first session.

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

Miscellaneous:

(1) Authorization to talk to another provider;

(2) Participation in workshops;

(3) Weekly log;

(4) Feedback Form Communication Exercises;

(5) Feedback Form Homefun Exercises.

 

*Please note that a client-therapy relationship is being established through the following: the person interested in treatment reviews the Individual’s & Couple’s Consent To Treatment form, initials where indicated, plus the person interested and Dr. Sibylle agree and both sign the initialed Individual & Couples’ Consent to Treatment form.

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