Important Forms

Below you will find several forms that may be necessary during your time in treatment.  Please download the necessary form and return to your next appointment with it completed. 

All Clients

These forms should be completed by everyone planning to work with Dr. Nyasio.

Electronic Communications Policy
Credit Card Authorization Form
Notice of Privacy Practices

Individual Therapy

Please complete these forms if you will be working with Dr. Nyasio for individual therapy.  Please have these forms completed before your first appointment or plan to arrive 15-minutes before your appointment so that you may complete these forms in the office. 

Individual Therapy Intake Form
Informed Consent Individuals

Couples Therapy

Please complete these forms if you will be working with Dr. Nyasio for couples therapy.  Please have these forms completed before your first appointment or plan to arrive 20-minutes before your appointment so that you may complete these forms in the office. 

Informed Consent Couples

Please complete these forms in accordance with your session number.

Session 1: Relationship Questionnaire
Sessions 2 & 3: Baseline Questionnaires
 Feedback Sessions
Session 5+: Weekly Questionnaires
Final Evaluation

Due to the COVID-19 pandemic, all sessions are held online.

1633 E. 4th Street, Suite 150, Santa Ana, CA 92701

Tel:657-267-7521 / Fax: 657-267-7522

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© 2019 by Tara Nyasio, PsyD