Location & Forms
Via Verde Counseling Office
1115 Via Verde - San Dimas, CA 91773
Located at the northwest corner of the intersection of Via Verde
and Puente in the Via Verde Professional Centre.
(If our parking lot is full please park across Via Verde in the Von's Center parking lot.
Our apologies for any inconvenience)
909 - 713 - 3396
FIRST TIME APPOINTMENT FORMS:
These forms may be *printed and completed prior to appointment.
- Consent Form (required for all clients)
- Personal Information Form (1 per attending adult)
- HIPAA Privacy Policies Statement (for your records)
- Family Information Form (Only required if you are attending as a family)
- Child/Adolescent Information Form (Required under age 18)
- Online Therapy Consent (Only required for online therapy)
*Forms can be printed by clicking on the above links then clicking the printer icon Ê at the top of the page or by clicking "file" and selecting "print" from the drop-down menu.
“Every change involves not only gaining something,
but losing something.
In many cases, what is lost may not be all that useful or effective,
but it is familiar and comfortable”
Jeffery A. Kottler
Individual Psychotherapy for Men and Women
Marriage Counseling - Affair Recovery
Childhood Abuse and Trauma Recovery - Parenting Skills
Anger Management - Family Counseling - Christian Counseling
Grief - Depression - Anxiety - Sexual Addiction
Treating Adults, Couples, Families, Adolescents, Seniors