Your First Visit

Please complete these forms ONLY if you have received a confirmed date and time for your initial assessment session. After printing and completing the forms below, please email or fax them in. (The telehealth form is only required for remote clients)

Email: sitwithsusan@gmail.com
Fax: (805) 618-1636

Please bring the following pieces of information to your scheduled appointment:

• Insurance card

• Photo ID

• Referrals (If required by your insurance)

• Co-payments (If required by your insurance)

The first appointment includes a Biological, Psychological, Social, and Cultural/ Spiritual Assessment.

English Forms

Spanish Forms

Financial Policy ​​

Prior verification of eligibility is required in order to use insurance as the method of payment. If insurance has not been verified, the appointment will be charged out-of-pocket and the fee will be collected at check-in.