Clinical Psychology Forms

The clinical psychology forms available below are the ones currently in use in our clinical practice.  The same or similar forms will be presented to you during your initial session and, as a condition to provide you with our professional services in clinical psychology, you will need to read and agree to the appropriate ones during your first session with your clinician.

We will gladly answer all your questions prior to your signing these forms.  After signing these forms, your clinician will give you a copy of the forms you signed for your records, as they constitute part of the professional services agreement to assist you.

The clinical forms are reproduced here in case you want to refer to these documents prior to your first appointment, or for future reference.  Please note we reserve the right to modify these documents to keep abreast with standards of practice and our professional judgment.

I expect that these clinical forms will also be of help to advanced graduate students in psychology and early career psychologists.  I hope these forms help you onto a most rewarding path.  Do ask me if you have any questions.  You may click on Contact Us as a quick way to reach me with your questions or concerns.  I enjoy helping new colleagues as they wet their feet in the profession.

I would also hope that the seasoned psychologists that may visit these pages benefit me with your wisdom in helping make improvements on these documents.  Any and all contributions are greatly welcomed.  Again, please click on Contact Us to share with me your thoughts and suggestions.

The content of this Internet website, and all its different documents, media, and publications, unless otherwise indicated, is of the authorship and the intellectual property of Angel Enrique Pacheco, Ph.D., C.Psych.  Please click to see our complete Copyright Notice statement.

Permission to use these publications is hereby granted for personal, professional, training, and/or academic/educational purposes, as long as the source is properly acknowledged, the use is not-for-profit, and that, preferably, you inform me in writing as it feels good to know I have been able to help someone!

All other uses of these publications require our prior permission in writing.


The links below open images, documents, or presentations which, unless otherwise indicated, are of the authorship of Angel Enrique Pacheco, Ph.D.  We hope they are of use to you.

As new publications are made available, we will include them in the appropriate sections of this website.  We may also update the content as necessary to comply with new information, regulations, or professional practice standards.  Visit us often to enjoy the publications to help you Learn to Live Better ®.

It must be understood, however, that these publications are made available to you to enhance the therapeutic relationship you may be participating in, and, as such, they should not be used as a substitute for professional mental health services.

The links to these publications open in a new page  while keeping open the main page.  To return to the main page you may simply close the new page, and/or click Alt + Tab in your keyboard.

The use of these publications is governed by the terms of our Copyright Notice.


Informed Consent to Participate in Psychological Therapy

 Informed Consent to Participate in Psychological Services and Limits of Confidentiality

Informed Consent to Participate in Psychological Services and Special Limits of Confidentiality for Minors

Informed Consent for Telepsychological Services 

 Informed Consent for Psychological Assessment

 Informed Consent for E-Mail or Text Communication

 Privacy and Confidentiality Policy Summary

 Privacy Policy

 Cost Sheet – Psychological Therapy

Cost Sheet – Psychological Assessment

 Consent to Disclose Personal Health Information v. 1

 Consent to Disclose Personal Health Information v. 2

 Withdrawal of Consent to Disclose Personal Health Information




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