Contact Information

NEW CLIENT
ADULT INTAKE FORM

Thank you for considering us for your counseling needs.

 

To request an appointment we'll need some information from you to get started. Please complete our new client form to save time during our first session. 

At the beginning of our first session, our therapist will briefly review the information provided to make sure we have all information required. We will also explain our policies regarding confidentiality and fees associated with your therapy. During your appointment, please feel free to ask us any questions you have about therapy; as we are here to serve you and to make you comfortable during this process. If you would like a copy of our HIPAA Privacy Practices you can review them here.

Sex
May the therapist leave a voice or text message?
If necessary may we send mail to your address?
Marital Status

Appointment Time Preferences

Which days of the week do you prefer? ( (select all that apply)
Time of day you prefer? (select all that apply)

Therapist Preference

PLEASE SELECT TWO (2) THERAPIST OPTIONS FROM ONE (1) CATEGORY BELOW

CATEGORY 1 - Licensed

CATEGORY 2 - Registered

CATEGORY 3 - Trainee/Intern

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need help? have questions? give us a call or complete our online APPOINTMENT form today.

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Hours of operation 

Mon-Fri: 9AM to 5PM

After Hours & Saturday by appointment only

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LOCATIONS

         Morgan Hill

         16275 Monterey Road, Suite C
         Morgan Hill, Ca 95037

         Gilroy

         8351 Church St, Suite E
         Gilroy, Ca 95020

         Cupertino

         21710 Stevens Creek Blvd. Suite 105

         Cupertino CA 95014     

 

Mail: counselors@mydiscoverycc.com

Tel: 408-778-5120

get in touch

Board of Behavioral Science - hOW TO FILE A Customer Complaint