Robin Furner, MFT
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Forms

For new clients coming to an initial session:  

Required New Client Forms:
Please print and complete the following forms: Client Assessment Form, Client Intake Form and Office Policies & Consent for Treatment Form.  Feel free to leave any questions blank that you would like to discuss with me.  If you prefer, I can also provide copies of these forms at our initial appointment.  

Optional:
If you would like for me to exchange information with someone else, such as a psychiatrist or other healthcare provider, I will need your written permission to do this. Please complete the Authorization to Exchange Information if you would like for me to consult or coordinate care with other healthcare providers.


Client Assessment Form:
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​​client_assessment_form_rfurner.pdf

Client Intake Form:
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​
client_intake_form_rfurner_2017.pdf

​

Office Policies & Consent For Treatment Form:

consent_for_treatment_rfurner_mft_04-18.pdf
​

Authorization to Exchange Information (optional):
​
authorization_to_exchange_info_rfurner_mft_2017.pdf

About Me:  www.robinfurnermft.com/about-me.html                                                                                                                                                                                                
Therapy FAQs:   www.robinfurnermft.com/therapy-faqs.html 

Contact Me:   www.robinfurnermft.com/contact-me.html                                                                                                                                                                                        
Forms:   www.robinfurnermft.com/forms.html                                                                                                                                                                                                          
       

Robin Furner, MFT          
Marriage & Family Therapist  
4000 Broadway, Suite 1, Oakland, California  94611                                                                                                                            
Phone: (510) 463-1465   
                     
                                                                                                                                                                                                                   
  • Home
  • About Me
  • Therapy FAQs
  • Contact Me
  • Forms