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Forms

Current & Perspective Clients

Please go to your Simple Practice Client Portal to access documents.

Forms must be completed no later than 3 days after scheduling your session. 

Your client portal will have the initial forms you need to complete before your first session. You will have other forms or surveys requested throughout the therapy process to monitor your symptoms.

  • You are able to request your sessions from this site. Your appointment is secured when you receive a confirmation. Please complete forms once confirmation is received.
  • We will go over any questions you have about the forms during your first session. You can also email me prior to the session with any questions or concerns. 
  •  The first session will be a getting-to-know-you time, that includes the initial assessment period and discussion of what you’d like to work on in therapy.  

Information provided on all forms is used to learn about your history, stressors, goals for therapy, and current situation that may require addressing immediately. 

Forms are sent via your Simple Practice Portal. 

Please complete at least 3 days prior to your session.

Release of Information (completed if needed, only)

Sexual Health Form (will be added soon)

How Are You Feeling (will be added soon)

Who’s Your Support System (will be added soon) 

Good Faith Estimate Explanation (added soon)

Reach Out To Me At:

(408) 763-9546 

Email: CherisseGage@

BreatheAgainTherapy.com

A Transgender, Gender Identity, Gender Expression, & Sex Worker Affirmative Therapist.

Online Therapy Available
Looking forward to Supporting your goals
Business Hours

Sessions

1:00 pm – 5:00 pm (Monday)

8:00 am – 2:00 pm (Tuesday)

8:00 am – 5:00 pm (Thursday)

Other Services

Wednesday & Friday

 

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