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Uta Russell, LCSW

Licensed Clinical Social Worker in Davis, CA

Forms

For new clients – please complete the following forms and bring them to your first therapy session:

Client Information Sheet

Client Therapist Agreement

Telehealth Consent Form

Notice of Privacy Practices

If you are a parent or guardian bringing a minor to therapy, please complete these forms in addition to the two above:

Agreement for Adolescent Meeting with Therapist

Consent To Treat Minor

If you would like me to speak to another provider, such as your primary care physician or your psychiatrist, to coordinate our care for you, then please complete the following form and bring it to our session. It allows for an exchange of confidential information:

Release of Information

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