559-824-4258 | alice@telementalhealthcalifornia.com

Alice E. Witt, LCSW

  • Alice E. Witt, LCSW
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Client Forms

If you are new to therapy or counseling, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy and allow as much time as possible to focus on you.

Client Intake

Client Information

Limits of Confidentiality

Fill out the next form if you would like to collaborate your sessions with another mental health advisor.

Authorization for Release of Information

Alice E. Witt, LCSW

559-824-4258
Send Me an Email

Mailing Address:
2035 Rancho Caro Rd,
Templeton, CA 93465

Got Questions?

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Contact Information

Mailing Address:
2035 Rancho Caro Rd,
Templeton, CA 93465

559-824-4258
alice@telementalhealthcalifornia.com

Find My Office

How to Get Started

Download my intake paperwork to prepare yourself for your first session.
Client Forms

Office Hours are Available by Request. You can also schedule a consultation session with me.
Request Appointments

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