Marilyn Levy


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Forms - Print Version



NEW CLIENTS PLEASE NOTE:


PRINT THESE FORMS, COMPLETE AND BRING WITH YOU TO YOUR FIRST APPOINTMENT.


NEW CLIENTS: ALL SIX OF THESE

FORMS MUST BE COMPLETED.


(Existing Clients may only need to

complete the Teletherapy form.)


TELETHERAPY FORM


NEW CLIENT FORM - PART 1


NEW CLIENT FORM - PART 2


NEW CLIENT FORM - PART 3


RELEASE OF MEDICAL INFORMATION


RELEASE OF INSURANCE INFORMATION



You Can Take Your Life to the Next Level!



Marilyn Levy, LPC
Psychotherapist
Certified EMDR Specialist
Tucson, Arizona 85710-4211


My office adheres to all Covid-19 recommended procedures. I adhere to all cleanliness standards and I am committed to providing an environment conducive to your comfort. Teletherapy Sessions are available for anyone in the state of Arizona who prefers to receive counseling in their own space.