Forms Directions

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Here is the paperwork necessary to begin your therapy. Please read through these documents thoroughly so you will know what to expect in working with Dr. Kelly. The forms must be read completely and signed for your first appointment, and updated annually for continuing or returning clients.

You may print these out and complete them at your convenience, bringing them with you 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 or you may complete the forms at the office on the day of your appointment. If you plan to complete forms on the day of your appointment please arrive early (at least 20 minutes) to allow enough time to read through and complete all forms before your scheduled appointment time. Please let us know if you will need forms on the day of your appointment so Dr. Kelly can leave them for you in advance as she will likely be in a session when you arrive.

Please note: If you would like Dr. Kelly to obtain confidential information about you from another provider, share information with another provider or otherwise coordinate your care by sharing your confidential information (for example, with your psychiatrist, primary care physician, etc.), complete the Authorization to Share Information form below which permits the sharing of your confidential information according to the limitations you set. NOTE: In the instance of telepscyhology 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 a telepsychology 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

Informed Consent - Treatment Contract

Notice of Privacy Practices

Authorization to Share Information

Informed Consent for Telepsychology

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. Stay to the left as you approach the Festival of Arts/Laguna Playhouse grounds on your right, and take the next left onto Forest Ave. Continue on Forest Ave. past Ocean Ave as it curves, turning right at the stop sign in front of the Fire Dept. You will go past two stop signs, the second at Glenneyre St. Turn left on Glenneyre. The office at 380 Glenneyre, Suite D is just past Mermaid St. on your left (see driveway into parking area on left in the middle of the block) before you reach the next stop sign at Park Avenue. Make a left turn through the breezeway into the parking lot of the 380 Glenneyre St.building.

From North of Laguna on Pacific Coast Highway: Take PCH south until you pass Main Beach in Laguna (basketball courts and beach on right, two gas stations on left.) Go two more lights and left at the second light, Forest Ave. At the stop sign turn right onto Glenneyre St. Just past Mermaid St. (the first street on your left,) turn left into the driveway for the 380 Glenneyre St. building and parking.

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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). Go right on Laguna Ave. to the 4-way stop. Go left onto Glenneyre St and almost immediately right into the driveway for 380 Glenneyre St.

Suite D is located on the second floor , to the right at the top of the stairs coming up from the parking lot. There is an engraved plaque beside the entrance door that reads "The Psychology Center". I look forward to meeting and working with you.

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Parking: The three parking spaces at the rear left side of the lot are labeled "The Psychology Center." You may park in any of these spaces if open. If all those spaces are full, there is metered parking on the adjacent streets. There is a metered parking lot next door across Mermaid on Glenneyre and a two-story brick parking structure with meters one block past the office on Glenneyre on the right as you go up the hill.

Helpful Forms

Click here to view and print forms for your appointment.

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