Jane B. Smith, M.S., LMFT Counseling for Individuals - Couples - Teens - Families

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Jane B. Smith, M.S., LMFT
530-677-2653
3939 Cambridge Rd. #110
Cameron Park, CA 95682
jane@roadtowellbeing.com
Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Client Psychotherapy Intake Form
Limits of Confidentiality/Therapy Cancellation Policy
Authorization to Disclose Information Form

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