KATRINA M ZELJAK, LMFT 99775, RPT T-3566 6994 El Camino Real, Ste. 205, Carlsbad, CA 92009 760 815 2525, tzeljak.cccc@gmail.com, www.katrinazeljaklmft.com

California law requires that parents or legal guardians be provided with information to allow them to make informed decisions about their child's participation in psychotherapy. This document provides information on risks and benefits of psychotherapy, medical concerns, assessment, the need for children and adolescents to have confidential psychotherapy, collateral contacts, treating children of separated or divorced families, professional records, confidentiality from third parties, alternative treatments, goals and length of treatment, psychotherapy fees, cancellations, and emergencies. Please read this information carefully, ask any questions you may have, and as these issues are understood, please initial in the places provided.