I understand that payment is due at each session unless specific arrangements are made and noted below. I understand that missed or cancelled appointments will incur a charge unless 24 hour notice is given.
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Licensed Marriage Family Therapist, #51176
208 Providence Mine Road, Suite 122
Nevada City, CA 95959
New clients please complete this confidential intake form and submit it to Aida.
If a certain question does not apply, please indicate by marking "N/A." Thank you.