Couples Intake Form

Couples Relationship Questionnaire

Individual Intake Form

EMDR First Session Forms



  1. WHAT YOU DO:  Email me at;   In the email, write list the dates of service that you would like to be documented.
  2. Then, I will email you a signed form that has the appropriate tax id info, license number, diagnosis info, and services provided codes that the insurance company may need to properly document the services having been provided. 
  3. Then you will use information on that form to fill out a form that your insurance company gives you.  Make sure you have them reimburse you and not me because you will have already paid me.  Typically they make you hit your deductible first, then reimburse you a predetermined percentage of the fees charged.

For Help With Couples Counseling, Couples Therapy, Emotion Focused Couples Therapy, High Conflict Couples, Communication Skills, Marital Fights, Divorce, Infidelity, is Todd Harvey, a Male Therapist who has an office in Berkeley, in Rockridge on the border of Oakland.

Couples Counseling and Couples Therapy in Berkeley, serving the Oakland, Albany, El Cerrito, Piedmont, Emeryville, Richmond, El Sobrante, Orinda, Lafayette, Walnut Creek, Alameda, Grand Lake, Lake Merritt, Rockridge, Piedmont Avenue, Temescal, Montclair,East Bay, Bay Area, and San Francisco Bay Area. And easy access to the following zip-codes: 94701, 94702, 94703, 94704, 94705, 94706, 94707, 94708, 94709, 94710, 94712, 94720, 94577, 94601, 94602, 94603, 94605, 4606, 94607, 94609, 94610, 94611, 94612, 94613, 94618, 94619, 94621, 94704, 94705, 94707, 94620, 94706, 94608, 94609, 94803, 94820, 94563, 94549, 94579, 94598, 94595, 94596, 94502, 94501.

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