Emilio A. Yonta, PhD, LCSW, CAP Pyschotherapy, Christian Counseling, Life Style Coaching

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Emilio Yonta, Dr.
(386) 756-2405
coachyonta@yahoo.com
Helpful Forms

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

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Limits of Confidentiality/Therapy Cancellation Policy Limits
Authorization to Disclose Information Form Authorization
Intake and Treatment Consent for Adults Intake
Consent Agreement for Children and Adolescents Intake
Core Release of Information Release to Disclose
Payment Agreement Payment Agreement
Focal Groups Registration Form Focal Groups Registration

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