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Allison Mupas, LMFT
Psychotherapist
Lic. #46004
Certified Hypnotherapist
Certified NLP Practioner

Monday-Friday
248 E Foothill Blvd, Ste 204
Monrovia, CA 91016

Daytime and Evening Hours Available

 626.802.7383
changeseekers@yahoo.com

Transpersonal Psychotherapy
Humanistic Therapy
Cognitive Behavioral Therapy
Conversational Hypnosis
Clinical Hypnosis
Hypnotherapy
Individual Counseling
Family Counseling
Couple's Counseling
Neuro Linguistic Programming
Regression Therapy
Solution Focused Therapy
Life Coaching
Spiritual Psychotherapy
Mind/Body Psychotherapy
GLBT Therapy

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Serving the communities of Monrovia, Pasadena, South Pasadena, Temple City, Baldwin Park, Arcadia,
Duarte, Altadena, Sierra Madre, San Dimas, Azusa, Glendora, Covina and the entire San Gabriel Valley
 
 

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THERAPY FORMS

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

    • Client Intake Form
    • Disclosure and Consent for Services
    • No Secrets Policy for Couple's and Family Therapy Only
    • Telemedicine Consent From
    • Notice of Receipt of Privacy Practices - (For you to read and keep do not need to bring in)
    • Acknowledgement of Receipt of Privacy Practice
       
     
                 
    • Teen Consent (Only for teen clients)
    • Alcoholism Questionaire 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician,or any family members etc.), complete this form:

  • Authorization to Release Information
Client Intake Form  
Disclosure and Consent for Services  
No Secrets Policy for Couple's and Family Therapy  
Notice of Receipt of Privacy Practice  
Acknowledgement of Receipt of Privace Practices  
Teen Consent Form  

Telemedicine Consent Form  
Authorization to Release Information  
Alcolholism Questionnaire  

Note: To download Adobe Acrobat Reader for free, click here.

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