Thank you for connecting with Perales Therapy, an initiative of SFC Change. Please know that this a HIPPA secured form and completing this form is required for services. These documents must be submitted prior to our first appointment. You can call if you have questions about these forms if you would like clarification prior to our session.

These are all the forms contained in the electronic version above.

Click on images to download. Send via email/fax/mail.
They must arrive prior to our first appointment.

Notice of Privacy Policies -REQUIRED

This form is a summary of your rights to privacy and access to your records. This is according to state and federal laws.

Therapy Agreement - REQUIRED

Informed consent means that you have a right to know about the services you are about to take before you make a decision to engage in the treatment. In fact, you don't really become a "patient" until this is signed and we have our first session outlining what kinds of concerns you have, possible diagnosis, and agreement on treatment. This outlines many questions that patients have about therapy but it is not exhaustive. Please always ask questions at the start of services or anytime during treatment.

Registration and Signature Form - REQUIRED

This is all of your pertinent information, including your residency address, which must be in Texas or Nevada. An ID number may be asked as a proof of residency. Signing this document means you also ready the above 2 documents as well.

Fee Agreement - REQUIRED

This outlines the fees and methods of payments for services.

Consent to Release Information - optional

Please download and fill out this form if you are receiving care from another provider.
Examples include:

medical providers
psychiatrists
couples, group, individual or family therapist

This form is not required to begin or continue treatment but it is helpful if you have it already filled out before we start. We will discuss as it's applicable to your care.