VEBA Therapy Intake Form Bundle for Provider Jeanine Bourcier, LMFT, DHS

 

Please complete all forms at least 24 hours prior to your therapy appointment. All required fields must be completed. After completing each document, please be sure to click the “Submit” button.

Informed Consent for Psychotherapy
Intake Form
Patient Health Questionnaire (PHQ-9)
General Anxiety Disorder Questionnaire (GAD-7)

Kindly arrive 10 minutes before your scheduled appointment and please be mindful of the following:

Cancellation/Rescheduling – if you need to cancel or reschedule your therapy appointment, please contact the VEBA Resource Center by calling (619) 398-4220 or emailing [email protected] within 24 hours of the scheduled date/time of your session. Canceling and/or rescheduling of three sessions will result in losing your preferred appointment time/date.

No Show – you will be considered a “No Show” if you do not arrive within 10 minutes of your session start time. VEBA Care Coordinator will attempt to reach you and reschedule however you will lose your preferred time/date. Two missed appointments without notice will result in losing your preferred appointment time/date.

If you need Child Care during your in-person appointment at the VRC, please register: Child Care Registration.