client forms &


client forms &


Appointments are available between 9am – 6pm during the week. Additionally, interns may be available to provide services during evenings and weekends as needed. For additional information, to discuss your needs, or to arrange an intake session, please fill in the form below or call us at (510) 926-8552 or email.

New clients may contact Dr. Perry’s office for appointments by completing the form below.

Established clients may use the patient portal to view, change, or schedule an appointment.


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

Client Psychotherapy Intake Form (.pdf)

Limits of Confidentiality/Therapy Cancellation Policy (.pdf)

Authorization to Disclose Information Form (.pdf)
If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information.


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