Inspired Mind Counseling
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Please download and complete these documents 48 hours prior to your initial appointment. Please email them to me at imclmft@gmail.com. Thank you!

NB: Only sign the "Authorization to Release Information" form if you'd like me to share your information; otherwise, please leave it blank. 
intake_forms_v09042022.pdf
File Size: 349 kb
File Type: pdf
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intake_espanol_v09042022.pdf
File Size: 312 kb
File Type: pdf
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intake_francais_v09042022.pdf
File Size: 329 kb
File Type: pdf
Download File

Inspired Mind Counseling
Madeleine Burkhart, MS, JD, LMFT 

(925) 528-1363

Get Inspired.
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