9550 Warner Ave, Ste. 250-08, Fountain Valley, CA 92708
Phone: (714) 403-4166
jackie.harlan@hotmail.com

Please print and fill these forms out before our first session. This will ensure that we use our time together getting to know each other, and not filling out paperwork. If you have any questions regarding any of the forms, please don't sign them and just bring them with you; I will address any concerns or questions before we start the intake process.

​​Dr. ​Jacquelyn M. Harlan

Licensed Marriage and Family Therapist

For teletherapy, please fill out these forms in addition to the forms above.

​​Telehealth Forms