Rev. Dr. Charles Asher, D.Min, MFT Lcs 24322
805-705-2451
47 Sixth Street
Petaluma, CA 94952

North Bay/Sonoma County

Additional office:

2220 Fillmore St. #1
San Francisco, CA 94115
805-705-2451

San Francisco County

charles@drcharlesasher.com

HELPFUL FORMS

If you're a new client, please complete the following forms found in the six links below and bring them to your first session.

  • Consent for Treatment
  • Office  Guidelines
  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information. Regardless, please read Patient Rights and HIPPA Authorizations (page 2 of 2) 

  • Authorization to Disclose Information Form
  • For Couples Only: No Secrets Policy
     
Note: To download Adobe Acrobat Reader for free, click here.

userfiles/581955/file/Consent%20for%20Treatment.pdf
 
Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form




 
 
   


              
userfiles/581955/file/NoSecretsPolicy.pdf  
 
 

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