ALL NEW CLIENTS
Contact Dr. Chapline and she will have her office manager email you forms to be completed and returned once you have a scheduled psychotherapy appointment.
UCLA PROBLEM GAMBLING STUDY CLIENTS
Please print and fill out the following additional forms (required to enter the program) and bring them to your first therapy session.
Declaration of Clients Rights and Responsibilities
Client handbook booklet
Consent to Telephone Monitoring and Follow Up Interview
Terms and Conditions of Service
Notice of Privacy Practices and Information Practices Act
Consent To Release Confidential Information
Request to Revoke Consent
Patient Intake Form
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