Our time together is very valuable. If you are requesting psychotherapy please download, print, complete and sign the following forms. Please mail the documents to:
Mary Jane DeWolf-Smith, LMFT,
5 Luzanne Circle,
San Anselmo, CA 94960.
After my review of your documents I will contact you and identify the best way to proceed.
Thank you.
Adult Intake Form
Adult Agreement for Services
Consent for Telehealth
Receipt of HIPPA Notice of Privacy Practices
Note: To download Adobe Acrobat Reader for free, click here.
Mary Jane DeWolf-Smith, LMFT
5 Luzanne Circle,
San Anselmo,CA. 94960
Please read this document. (No need to print, sign or return.)
HIPPA Notice of Privacy Practices