Helpful Client Forms

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.

Download, print out, complete and sign four (4) forms and mail to:
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