Debora Kreimer, MS, MFT
Licensed Marriage & Family Therapist
MFC 47058
818-456-9936
Psychotherapy for Empowerment, Healing & Growth
Copyright 2009-2010 Created, Written and Published by Debora Kreimer, MS, MFT
Licensed Marriage and Family Therapist in the San Fernando Valley
Forms
This form will provide you with a detailed
explanation of services provided and my
office policies.  Please s
ign and bring to
session to be filed in your chart.
 Please
retain a copy for your records.
This form is an administrative form that will
provide me with confidential client
information for insurance purposes as well as
symptomatic information for therapeutic
services. Sign and bring to session to be filed
in your chart.
This form is for informational purposes only.
Retain for your records.
This form needs a signature to acknowledge
receipt of HIPPA.  Sign and bring to session to
be filed in your chart.