Iris Alegria Chazenbalk
Psychotherapy for Individuals, Couples & Families
4405 Riverside Drive, Suite 208. Burbank, CA 91505. Phone: (323) 634-4812. Email: iris.mft@gmail.com

Services Provided
in
English and Spanish
FORMS

If you are a new client, please complete the following forms and bring them to your first therapy session:


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


Note: All forms are PDF forms; you will need Adobe Acrobat Reader to open the forms. If you don't have the reader,
you can download it by
clicking here.
For a consultation call: (323) 634-4812
Page Updated: February 2018