New Client Paperwork

For minors, all clinic paperwork must be filled out prior to starting the process of becoming a client at CCS. Paperwork must be signed by both individuals who hold custody [e.g., biological parents, legal guardian(s), custodian(s), conservator(s)]. 

If there is any type of legal paperwork or documentation involved, whether it is court-ordered counseling or custody arrangements, CCS will need full and complete copies of these documents along with the paperwork below. All court orders and custody paperwork must be provided to CCS in its entirety and all pages must be provided. Please return all the paperwork below to the clinic and in the first in-person appointment, the clinician will review all paperwork with clients.

Paperwork can be returned by faxing it to the Westlake Village Clinic at (805) 493-3388 or the Oxnard clinic at (805) 485-0170. Paperwork can also be brought to the clinic in-person or mailed. 

Below is a full list of all required paperwork for both English and Spanish.

Paperwork for Minors 

  1. Informed Consent (English, Spanish
  2. Consent to Treat Minors (English, Spanish
  3. Supervisor Disclosure and Consent to Record (English, Spanish
  4. Child/Adolescent Information Sheet (English, Spanish
  5. Child Strengths (English, Spanish
  6. Disclosure Surrounding Legal Issues (English, Spanish
  7. Fees Form (English, Spanish
  8. Consent to Telehealth (to be signed starting March 16th) (English, Spanish)

Paperwork for Adult Individuals

  1. Informed Consent (English, Spanish
  2. Supervisor Disclosure and Consent to Record (English, Spanish
  3. Demographic Information (English, Spanish
  4. Client Strengths (English, Spanish
  5. Legal Disclosures (English, Spanish
  6. Fees (English, Spanish
  7. Notice to Consumers (Print and Keep) (English, Spanish
  8. Consent to Telehealth (to be signed starting March 16th) (English, Spanish)

Paperwork for Adult Couples

  1.  Informed consent (Both can sign) (English, Spanish
  2. Supervisor Disclosure and Consent to Record (Both can sign) (English, Spanish
  3. Demographic Information (need one for each client) (English, Spanish
  4. Client Strengths (need one for each client) (English, Spanish
  5. Legal Disclosures (Both can sign) (English, Spanish
  6. Fees (Both can sign)  (English, Spanish
  7. Notice to Consumers (Print and Keep) (English, Spanish
  8. Consent to Telehealth (to be signed starting March 16th) (English, Spanish)

 

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