• Contact Now Schedule a Free Consultation

    Diane Smith, MA.
    Marriage & Family Therapist
    #111553 CEFT

    diane@dianesmithcounseling.com | (805) 419-0151

  • Diane Smith

    My WordPress Blog

    • Home
    • About
    • Services Provided
      • Telehealth Counseling
      • Couples Counseling
      • Counseling for Anxiety
      • Counseling for Depression
      • Grief & Bereavement Counseling
      • Family Counseling
    • Getting Started
      • FAQs
      • Rates and Insurance
      • Client Forms
      • Appointment Request
    • Resources
      • Recent News
      • Mental Health Links
      • Physical Health Links
    • Contact
    • Blog

    Client Forms

    Once we determine working together will be our best course of action, I will send you a link to access a personal and private client portal within my practice management system. Once within the client portal, you will be able to have access to all forms which can be filled out electronically.

    Contact Today



    (805) 419-0151 diane@dianesmithcounseling.com

    Contact Today

    By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

    Diane Smith Counseling
    diane@dianesmithcounseling.com | (805) 419-0151

    A Website by Brighter Vision | Privacy Policy