Positive Change Counseling Services 2050 Peabody Road, Suite 300, Vacaville, CA 95687
Please print and fill out appropriate forms
*Intake
*Consent to Treat
*Privacy Practices
Consent to Treat --Brittany Kohlberger, PhD (pdf)
DownloadConsent to Treat --Phillip Boone, AMFT (pdf)
DownloadConsent to Treat--Nicholett Bascou, APCC (pdf)
DownloadConsent to Treat--Rose Garcia, ACSW (pdf)
DownloadAdult Intake (pdf)
DownloadMinor Intake (pdf)
DownloadPrivacy Practices (pdf)
DownloadInformed Consent Form - NBascou (pdf)
DownloadInformed Consent to Treat - Carmelita Horne; LMFT, LPCC (pdf)
DownloadWe are currently utilizing a HIPAA compliant video conferencing platform to support your efforts of maximizing the safety of yourself and the ones you love.
National Suicide Prevention Hotline 1 800 273 TALK
National Sexual Assault Hotline 1 800 656 HOPE
Safequest (DV & sexual assault) 1 866 487 7233
Solano County Crisis 1 707 428 1131
MediCal/Beacon/Partnership 1 855 765 9703
Emergency 911
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