Welcome! Before we start our therapy sessions, there is a series of forms that I need you to review, complete, and e-sign.
When you make your first appointment with me, I will ask you for a private email address where I can email an invitation to create a secure client portal on my site. From this portal, you will be provided agreements to download for your records. You will also be asked to sign these agreements electronically.
Next, I will gather some client intake information about you, your living/work/school situation and your family medical history. The whole online intake process should take 10 ~20 minutes. Having your phone book handy with your doctor’s name and number, emergency contact name and number will help speed up the process.
Answer the intake questions as much and as best as you can on your own. This way we can devote more of our first session addressing your health concerns and less on paperwork. Of course, if you have questions and concerns about anything on these forms, we can discuss those at our first session.
Existing Clients: Log into Client Portal here >> Shalini Dayal, MFT #43574 Secure Portal
Individual Forms for download for your review. #E1-HIPPA Notice of Privacy Practices,Rev 2/18 #E2-Acknowledgment of Receipt of Notice of Privacy Practices #E3-Disclosure Statement & Agreement for Services #E4-Patient - Healthcare Provider Electronic Communications Agreement Optional Forms:- #E5-Authorization to Release Confidential Information
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