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Protzel Therapy, Inc.

  • Home
  • About
  • Services
  • Forms & Payment
  • Resources
  • Contact
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Forms & Payment


Forms & Payment

 

Downloadable Forms

  1. Informed Consent Form

  2. Intake Form

  3. Release of Information Form

  4. HIPPA & Client Contact Forms

  5. Telehealth Consent Forms

  6. Credit/Debit Card Authorization Form

  7. Cancellation policy Form

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  • Verified by Psychology Today

© 2015 Protzel Therapy 323-454-3041

Dr. Carlos Protzel, LCSW, PsyD
CA Licensed Clinical Psychologist (PSY 24612) & CA Licensed Clinical Social Worker (LCS26028)
Montana and Michigan Licensed as a Clinical Social Worker (MT Lic #25998 & MI lic #6801081335)
Verified October 19, 2015

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