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Debra Kessler, PsyD, RN, MN
License #19100

Dr. Debra Kessler's Intake Forms

To help you get started, Dr. Kessler's intake forms are available here allowing you to print and fill them out prior to your visit. Simply click the links below to open the forms.

To fill the forms out by hand, save them to your computer and print.

Please fill out the forms in * below before your appointment. Click on the links below to open the document.  Place your curser on the lines you are filling out, type your information, then print.

*Intake Form PDF

*Authorization Form PDF

Treatment Agreement Form PDF

*Treatment Agreement Signature page PDF

Office Privacy Policy PDF

*Office Privacy Policy Signature PDF

Addendum to Psychologist-Child Agreement:
Confidentiality with Minors and Parents PDF

Telehealth Written Consent Form PDF

Treatment Agreement When Treating Children of Divorce PDF

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Debra Kessler, California Therapist

Then, as the willow's leaves rustled
and brushed against my skin,
A whisper lilted upon my ear.
"Be strong, for that is the trunk of truth.
Bend, for that is the nature of your branches.
Lay your roots deep for that
is the beginning of all.
And if you chance to weep,
know that you will blossom from it."

Deverie

Dr. Kessler Nourishes the Seed of Growth

There is unrest in the forest,
There is trouble with the trees,
For the maples want more sunlight
And the oaks ignore their pleas.

The Trees by Rush

Dr. Debra Kessler is located near Glendale, California

And the day came when the risk
it took to remain tight in the bud
was more painful than the risk it
took to blossom

Anais Nin