Payments and Forms
I accept PayPal and Venmo. To pay with PayPal, please fill out the following form. Upon selecting “Pay Now” you will be taken to PayPal to finish your transaction.
To pay with Venmo, click here.
If you do not show up for your scheduled therapy appointment, and you have not notified me at least 24 hours in advance, you will be charged a Late Cancellation/No Show Fee of $275.
Prior to your first session, please download and complete the New Client Intake Form and Telehealth Consent Form using Adobe Reader. Completed forms can be emailed to email@example.com. However, please note that emails are not encrypted and there is a risk of exposure. If you do not want to send your completed forms via email, please notify us.
New Client Intake Form
Informed Consent for In-Person Counseling Services During COVID-19 Pandemic
Telehealth Consent Form
Contact Chambliss & Associates
Marriage and Family Therapy
Ask a question or book an appointment below.
(310) 303-9132 (Call or Text)
727 2nd Street, Suite 105
Hermosa Beach, CA 90254