SHIRLA DE MAGALHÃES, LMFT, RPT-S, RSP
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                                                               ​FORMS


Please click on each link below to complete intake forms before our first session. Forms will be submitted to therapist electronically.

For Minors ( 3 Forms)
  1. Child & Teen Intake Form  (please allow enough time to complete this form as it has several questions )​​
  2. Informed Consent For Minors & Office Policies
  3. Child & Adolescent Parent Questionnaire - CBCL 
 If you are are paying out of pocket (not using insurance), please review and sign the No Surprise Act Form:
  •  No Surprise Act Form (For Self-Pay Clients) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Adults 18+ (2 Forms)
  1. Adult Intake Form (please allow enough time to complete this form as it has several questions )
  2. Adult Informed Consent & Office Policies​
If you are are paying out of pocket (not using insurance), please review and sign the No Surprise Act Form:
  • No Surprise Act Form (For Self-Pay Clients)
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   Therapeutic Empowerment for Teens & Adults

   Shirla de Magalhães, LMFT, RPT-S, RSP ~ License # 82947

​   8453 La Mesa Blvd, La Mesa, CA 91942 ~ shirlaplaytherapy@gmail.com ~ Tel: 619-797-6595


  • Home
  • About Shirla
  • Depth Psychology
  • Sandplay
  • SoulCollage®
  • Therapeutic Art
  • Play Therapy
  • Contact Me
  • Forms
  • Resources