Carolyn Mehlomakulu, LMFT-S, ATR-BC
Licensed Marriage and Family Therapist
Board Certified Art Therapist
Psychotherapy and Art Therapy for Children, Teens, and Families
Supervision for LMFT-Associates
Forms
Before your first session, I will send you all paperwork through my client portal. However, if you prefer, you may download a copy from this page and complete before your first session.
Intake Paperwork:
Child & Adolescent Clients: PDF
Adult Clients: PDF
Telehealth Forms:
Before any telehealth sessions, please complete this additional consent form and review the included instructions: PDF
Additional Documents Needed:
For divorced parents of minor clients, please bring a copy of the custody agreement to the intake session so that I may verify who may consent to treatment.
If you wish to use insurance, please bring a copy of your insurance card with you.
If there are other people that I will need to be in contact with regarding your treatment, please print and complete the Release of Information Form: PDF
Privacy Policy:
This policy is included with all intake paperwork forms. However, you may also review a copy here: HIPAA Privacy Policy
No Surprises Act Notice:
The "No Surprises Act" protects consumers from unexpected medical bills. If you are choosing to use services as private pay or out-of-network, you have a right to receive a Good Faith Estimate that clearly outlines expected costs before your first session.