Consent / Refusal for Collaboration

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I give permission for DV Therapy to discuss and release information to the behavioral health clinician.

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My child does not have a behavioral health clinician.

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Behavioral health clinician:

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Clinician's Phone number

Clinician's Address

Clinician's Email

My child does not have a primary care physician.

Yes

Primary care physician

Physician Name

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Physician Phone number

Physician Address

I give permission for DV Therapy to discuss and release information to the primary care physician.(Required)

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					<img decoding=async  src="https://mlzvkesrhmut.i.optimole.com/w:auto/h:auto/q:mauto/https://www.dvtherapy.com/wp-content/plugins/wp-review-slider-pro/public/partials/imgs/yelp_stars_5.png" alt="5 star rating" class="wprevpro_t1_star_img_file">I love bringing my little one here. I've notice such a big difference in her speech. And Ms.Rachel is amazing... read moreI love bringing my little one here. I've notice such a big difference in her speech. And Ms.Rachel is amazing just amazing. My little one is always excited to come and see her since day 1. Everyone here is amazing such great energy. I always see little ones come excited and leave excited! read less				
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Bianca C.
1 year ago

					My 2 year old son has been improving so much over the last few months & im very thankful for... read moreMy 2 year old son has been improving so much over the last few months & im very thankful for it ! Ms Natalie is so patient with him he loves going to see her ! read less				
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1 year ago

					Im beyond happy with the services my daughter is receiving. Her therapist Lupe has done an amazing job, from keeping... read moreIm beyond happy with the services my daughter is receiving. Her therapist Lupe has done an amazing job, from keeping her entertained during her in-person and Telehealth visit. Staff is super friendly and very welcoming 🙂 read less				
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2 years ago

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Consent / Refusal for Collaboration

Behavioral health clinician:

Primary care physician

Antelope Valley

Los Angeles

San Gabriel Valley

Bakersfield