SRP Forms

Before your first counseling appointment, please download the following two forms: the Personal Information Form and the Office Policies Agreement.  Please bring them with you to your first session.  If you have difficulty downloading them, please contact your counselor to make alternative plans to fill them out at the office.

Personal Information This provides basic information about you for your counselor.

Office Policies and Agreement  This explains important elements of the counseling process and forms an agreement between you and your counselor.  If a minor is the one participating in counseling, a parent needs to sign the consent.

Other forms that may be helpful for you:

Directions to the Soul Restoration Project office in Santa Ana.

Consent to Treat a Minor This is to be signed by a parent to counsel those under 18 years.

Authorization to Release Information  This form is necessary if you would like your counselor to exchange information with a doctor, therapist, school guidance counselor, etc.

Informed Consent for a Visitor in a Psychotherapy Consultation This form must be filled out if you invite someone to join you in a therapy session.


































Santa Ana
  1801-F Parkcourt Place, Suite 205
  Santa Ana, CA 92701
Long Beach
  6621 E. Pacific Coast Highway, Suite 110
  Long Beach, CA 90803