Contact Information

NEW CLIENT
FAMILY INTAKE FORM

Thank you for considering us for your counseling needs.

 

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


At the beginning of our first session, our therapist will briefly review the information sheet to make sure I have all information required for my records. We will also explain our policies regarding confidentiality and fees associated with your therapy. Please 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.

Family Member 1 - Sex
Family Member 2 - Sex
Family Member 3 - Sex
Family Member 4 - Sex
Family Member 5 - 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? (Selet all that apply)
Therapist Preferences

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

CATEGORY 1 - Licensed

arrow&v
arrow&v

CATEGORY 2 - Registered

arrow&v
arrow&v

CATEGORY 3 - Trainee/Intern

arrow&v
arrow&v
 

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

follow us on facebook

Hours of operation 

Mon-Fri: 9AM to 5PM

After Hours & Saturday by appointment only

Sign up to receive our newsletters

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