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      • Brittani L. Persha, LCSW-S, RPT-S, EMDR Trained
      • Rodrigo Cañedo, LCSW, EMDR Trained
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      • Stephanie Farugia, LMFT-A
      • Ashlee Bixby, LPC
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    • Brittani L. Persha, LCSW-S, RPT-S, EMDR Trained
    • Rodrigo Cañedo, LCSW, EMDR Trained
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    • Stephanie Farugia, LMFT-A
    • Ashlee Bixby, LPC
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713-364-8645
info@brittanipershacounseling.com

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Client Forms

If you are new to therapy or counseling, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy, and allow as much time as possible to be spent focusing on you.

Child Intake Form

Adult Intake Form

Sensory Checklist

Telehealth Informed Consent

Information and Informed Consent for Counseling Services

Notice of Privacy Practices

Alice Whitten Professional Disclosure Statement

Rodrigo Cañedo Professional Disclosure Statement

Parent Weekly Check-In Form

 

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Brittani Persha Counseling
1035 Dairy Ashford Rd., Ste. 220
Houston, TX 77079
713-364-8645
info@brittanipershacounseling.com
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Useful Links


Association of Play Therapy


Texas Association for Play Therapy


Children’s Advocacy Centers of Texas


Children’s Assessment Center (Houston)


The Theraplay Institute

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