Dr. Heloisa Portela, LPC

Therapy for Children, Adults, Families, & Couples

New Client Information


6512 Six Forks Rd, Suite 403B.

Raleigh NC 27615.


Tel: 919-368-5207

Fax: 919-882-9505


Welcome to Vida Counseling!

In preparing for your first appointment, please review and complete the following forms. The answers to the most common questions can be found in the Professional Disclosure file below. 


Forms for Adult Clients: 

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

- Professional Disclosure Statement & Informed Consent

- Adult Client Psychotherapy Intake Form

- Female Sexual Questionnaire

or 

- Male Sexual Questionnaire

- Eating Disorder Questionnaire (if you struggle with disordered eating issues)

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

- Release of Information 

* For marital counseling: please bring one of the above forms per partner. 


Forms for Minor Clients: 

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

- Professional Disclosure Statement & Informed Consent

- Minor Client Psychotherapy Intake Form

- Eating Disorder Questionnaire (if child struggles with disordered eating issues)

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

- Release of Information


Cancellation Policy 

Please note that the time scheduled for your appointment is reserved exclusively for you/your child. In light of this, you are responsible to pay for any appointment cancelled or rescheduled with less than 48 hour notice. The charge for missed appointments or appointments canceled with less than 48 hour notice is $75. Sorry, but there are no exceptions to this rule. 


Contact 

Questions? E-mail Dr. Portela for further information.

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