Counseling and Relationship Support Services include individual, mother-infant/toddler/child and family counseling, and Mindful Parenting Groups.
Some issues may include:
To schedule an initial consultation, or for more information, please call 310-402-2229 ext. 0, and our front desk associate will direct your call.
Preparing for your initial consultation...
For your convenience, please download and complete the following forms before your first appointment. You may either mail, fax, or bring forms in with you on the day of your appointment, however, three days prior to your appointment is preferable. Please fill out the following forms: 1) Client Information, 2) Consent to Treat Individuals, Couples or Families, 3) Adult Intake, and 4) Child and Family Developmental Questionnaire. (Each parent should fill out a separate Child and Family Questionnaire for each child receiving counseling.) In addition, every family member (including children) needs a 5) HIPAA Acknowledgement (with parents signing for their children, of course. HIPAA Document is for you to keep). For child therapy, please sign Consent to Treat a Minor instead of Consent to Treatment. If you and your spouse are not living together, are legally separated, divorced or in court proceedings, please include legal custody documents.
Sliding Fee Scale
If you would like to be considered for a reduced fee, please bring in proof of income in the form of last year's tax return or a pay stub from each parent's employment. We are a Blue Shield in network provider but will provide a Superbill for other insurance companies where we are not in network. We are also a vendor of Westside Regional Center.
HIPAA Privacy Practice Document
Child & Family Developmental Questionnaire
Consent to Treat Individual, Couples, and Families
You may fill out an Online Adult Intake by clicking here and then please save the completed form to your desktop and email it to info@wellbabycenter.org.
Adult Intake for printing only and to fill out manually