Forms Directions

authorizationtoshareinformation-2023-g.pdfauthorizationtoshareinformation-2023-g.pdf

                                                                 

Here are the forms necessary to begin your therapy. Please read through them thoroughly so you 

will know what to expect in working with Dr. Kelly. They must be fully read and signed for your 

first appointment.  Please print out and complete them at your convenience. Bring them to your 

first session.  

If you are not able to print them out, please contact Dr. Kelly and we can send you hard copies in

the mail.  You may complete them at the office on the day of your first appointment. If you plan 

to do so please let us know so Dr. Kelly can leave them in the waiting room for you, as she will may 

be in a session when you arrive. Please arrive early (at least 20 minutes) to allow enough time to 

read and complete all forms before the start of your appointment. 

The Authorization to Share Information is needed only if you want Dr. Kelly to obtain or release confidential information about you to another provider (e.g. with your primary care physician, a psychiatrist, etc.)  Your signed permission is required for sharing this information which will be 

shared according to the limitations you set.

 

NOTE: For teletherapy services, you will need to authorize Dr. Kelly to contact at least one emergency contact person who is nearby you in case an emergency situation arises during your session. Please feel free to ask about this or any other issue related to these forms.

We welcome your questions and Dr. Kelly encourages you to have all questions answered to your satisfaction prior to signing these agreements..

Client Information Form

Treatment Agreement/Informed Consent Form

Notice and Acknowledgment of Privacy Practices

Authorization to Share Information

Informed Consent for Teletherapy

Notice of Possible Service Disruption related to -19

Note: To download Adobe Acrobat Reader for free, click here . 

                                                                 

DIRECTIONS

From 405 or 5 Freeways: Take 133 South (Laguna Freeway) towards Laguna Beach. As you approach the Festival of Arts/Laguna Playhouse grounds on your right, stay to the left and turn left at the light at Forest Ave. Pass Ocean Ave. and turn right at the stop sign in front of the Fire Dept.  Continue through two stop signs.  Turn left at the next stop sign, Glenneyre St.  The 380 Glenneyre Building is just past Mermaid St. on your left (see driveway into parking area in the middle of the block) before you reach the next stop sign at Park Avenue. Turn left into the breezeway and the parking lot of the building.

From North of Laguna on Pacific Coast Highway: Take PCH south past Laguna Main Beach (basketball courts and beach on right, two gas stations on left.) Proceed to the fourth set of traffic lights, at Legion St.  Turn left on Legion St. At the first stop sign, Glenneyre St.,  turn left.  Follow Glenneyre St. past the 4-way stop sign at Park Ave. and Glenneyre St.  Turn right in the middle of the block into the breezeway and the parking lot of the 380 Glenneyre Building. 

From South of Laguna on Pacific Coast Highway: Take PCH north until you reach the intersection of Laguna Ave and PCH (at the corner of the Hotel Laguna). Turn right on Laguna Ave. to the 4-way stop. 

Turn left onto Glenneyre St and almost immediately right into the driveway for the 380 Glenneyre St. Building.

                                                                

PARKING

The building has a small customer parking lot shared by several businesses.  You may take an open slot if the sign says "The Psychology Center" (far left side) or "Health in Balance" (under the carport.)

IMPORTANT:  Please allow ample time for parking as you may not find an open space in the lot and may need to look for metered parking on an adjacent street.  There is a metered parking lot at the corner of Glenneyre and Mermaid  Sts. and a 2-story brick metered parking structure  one block up on Glenneyre St. as you go up the hill, - just south past the 4-way " Stop." at Park Ave. & Glenneyre St.

SUITE G

Suite G is located on the second floor at the rear of the building.  The easiest access is through the metal gate at the right rear of the parking lot and up the steps. Entrance is then on your right through the "G" door.