• Consent to Collect Personal Health Information

    Individual Psychotherapy
  • At Mindfulness with Mae, we collect your Personal Health Information during the therapeutic process to help determine the types of treatment that are most appropriate for you. 

    Personal Health Informaiton may include:

    • Your name, address and phone number
    • Your physical and mental health
    • Your personal health history
    • Issues that you are experiencing
  • I,     understand the potential risks associated with participating in psychotherapy and agree to take part in private, individual session(s).

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    Pick a Date
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