Virtual Therapy Forms

Self Registration Link (Adults)

Your therapist will send you a generated link via email. Please click the link in your email and fill out the self registration. If you have any questions, please email newclient@c4vl.com with your name and phone number and the best time to call.

Note: the Self registration process is not complete until you sign your name. Please continue to click the next button until the signature page appears.



Self Registration Link (Child)

Your therapist will send you a generated link via email. Please click the link in your email and fill out the self registration. If you have any questions, please email newclient@c4vl.com with your name and phone number and the best time to call.

Note: the Self registration process is not complete until you sign your name. Please continue to click the next button until the signature page appears.



Supplemental Forms

Please download and fill out the following forms.
Have them available at the start of your first virtual therapy appointment.



For Informational Purposes Only

These forms are not required but may be useful in advancing your treatment.

If you would like to pay by credit card, you will need to fill out this form. You can pay via credit card once or on a continuous basis. You will need to fill out this form again only if you change the frequency of credit card payments or if the credit card information changes.



By filling out this one-page form, you are authorizing Center for Valued Living, PLLC to consult with other people, whom you specifically select, about your treatment (e.g., physicians, lawyers, school personnel, family, etc.). You and your therapist would decide the nature of the information discussed with these other people before he/she initially consults with them. Consultation with anyone other than the person or people in treatment cannot occur without this written consent.



FOR INFORMATIONAL PURPOSES ONLY. You may read online or print to read but you do not need to bring in or give to your therapist. We will review the information in this form verbally at the beginning of your first session.



FOR INFORMATIONAL PURPOSES ONLY. You may read online or print to read but you do not need to bring in or give to your therapist. We will review the information in this form verbally at the beginning of your first session.

Back to Top