Make an Appointment: terri@terriolivatherapy.com | (650) 691-5653
Contact
terri@terriolivatherapy.com | (650) 691-5653

client forms

If you are a new client, I will provide you with a link to the Client Portal in which your intake forms can be filled out and signed digitally; reducing all physical paperwork. You can log in and out of the portal to create changes at any time…the forms below are examples of questions that may be asked and information provided by me:

Client Intake Form

Information Sheet

Limits of Confidentiality


3000 El Camino Real, Building 4, Suite 200, Palo Alto, CA 94306
terri@terriolivatherapy.com
(650) 691-5653

Got Questions?
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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

  • Have some questions first? You can always reach out here, or email me directly at terri@terriolivatherapy.com