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Raquel Vega Therapy

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Client Forms

If you are new to the working with me, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Agreement of Services

Client Bill of Rights

Client Intake

Limits of Confidentiality

What You Should Know About Confidentiality

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

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173 Huguenot Street Suite 200 New Rochelle, NY 10801 (646) 357-3775 raquel.vega.psyd@gmail.com

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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.

Raquel Vega
raquel.vega.psyd@gmail.com | (646) 357-3775

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