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Call Us Now

408-763-9546

Send a Message

cherissegage@breatheagaintherapy.com

Visit us at

17782 Moro Rd, 
Prunedale, CA 93907 

Forms

Current & Perspective Clients

Please go to your Client Portal (or download from here) to access documents. Forms must be completed no later than 3 days after scheduling your session, or it may be canceled.  (Primary forms needed: Intake, Informed Consent, Consent for Treatment, and Emergency Contact)

*Upload these forms to Simple Practice “Client Portal.” There may be additional forms to complete inside the portal.

  • You are able to book your appointment on this site, but the appointment is not secured until after the forms are 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 the forms is used to learn about your history, stressors, goals in therapy, and current situation that requires immediate addressing. 

Click on links below to view and complete form

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 Us At

(408) 763-9546

Online Therapy Services
In Person Services

17782 Moro Rd, 

Prunedale, CA 93907 

Business Hours

Sessions

7:00 am-4:00 pm (Wednesday & Thursday)

Other Clinical Services

Monday, Tuesday, & Friday

Copyright @ 2022 Breathe Again Therapy