Centre for Anxiety and Trauma

Diplomate Cognitive Psychotherapist Daniel Gomez ACT Mdiv LCSW LCADC CGP
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Daniel Gomez
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forms

 

 

 

Personal information

 

 

 

Release of information

 


 

The Above forms are available for client use:
 
 
 
Client Contact Form:
 
Please complete the Client Contact Form if:
  • You are a new client or
  • Your address, phone number or emergency contact has changed.
 
 
Authorization to Release Information:
 
Please complete the Authorization to Release Information form if you would like me to be able to speak with other treatment providers (i.e. your nutritionist, doctor, etc), family members or a treatment facility.