Dr. Jerry Brown
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Intake Forms

 

Helpful Forms

If you’re a new client, please complete the following forms and bring them to your first therapy session.

  • Client Agreement
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize the release of psychotherapy information:

  • Authorization to Disclose Information Form

 

Location
Dr Jerry Brown
1500 Adams Ave Suite 307 Costa Mesa, Ca 92626
(714) 403-1100

Specialties:

  • Addiction
  • Parenting
  • Testing and Evaluation
  • Issues
  • ADHD
  • Alcohol Abuse
  • Anger Management
  • Anxiety
  • Asperger’s Syndrome
  • Bipolar Disorder
  • Career Counseling
  • Child or Adolescent
  • Chronic Relapse
  • Codependency
  • Depression
  • Divorce
  • Drug Abuse
  • Dual Diagnosis
  • EAP (Employee Assistance Referral)
  • Eating Disorders
  • Family Conflict
  • Medication Management
  • Obsessive-Compulsive (OCD)
  • Professional board evaluations for relicensing
  • Relationship Issues
  • Self Esteem
  • Sexual Addiction
  • Stress
  • Substance Abuse
  • Suicidal Ideation
  • Mental Health
  • Impulse Control Disorders
  • Mood Disorders
  • Personality Disorders
  • Psychosis
  • Client Focus

I also speak:

  • Addiction and Recovery Language
  • Age
  • Adolescents / Teenagers (14 to 19)
  • Adults
  • Elders (65+)
  • Communities
  • Aviation Professionals
  • Treatment Approach
  • Types of Therapy
  • Family / Marital
  • Family Systems
  • Fluent in recovery issues
  • Forensic Psychology
  • Positive Psychology
  • Psychological Testing and Evaluation
  • Public speaking
  • Modality
  • Individuals
  • Couples
  • Family
  • Video/Skype
  • Online Counseling
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