Please review the information below to understand how to access and complete the required forms before your appointment.
ALL NEW CLIENTS
If you are a new client, please contact Dr. Chapline to schedule your psychotherapy appointment. Once your appointment is confirmed, her office manager will email you the required intake forms for completion and return prior to your session.
UCLA PROBLEM GAMBLING STUDY CLIENTS
Clients participating in the UCLA Problem Gambling Study are required to complete additional documentation. Please print, complete, and bring the following forms with you 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
Complaint Grievance
Patient Intake Form
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