Contact, Forms, and Payment
Contact, Forms, and Payment
Contact
Please contact me by phone or email with any questions you have about working with me or making an appointment. I will always take time on the phone to discuss what brings you to therapy before making an appointment. This gives you an opportunity to ask questions about how I work, experience with your issues and financial arrangements.
My office is located in Capitola on Bay Ave across the street from Nob Hill Market. There is free parking in the lot and overflow lot in-between my building and the Capitola Post Office.
I look forward to our working together and please remember to fill out my forms in advance and bring them with you.
LICIA GINNE, Psy.D.,MFT 21421
Mailing Address:
P.O. Box 181
Capitola, CA
95010-0181
Email:
DrGinne@gmail.com
Phone:
831 471-8647
Forms
To return the forms by mail please send them to my PO Box:
Licia Ginne
PO Box 181
Capitola, CA
95010
FORMS FOR NEW CLIENTS
The forms can be filled out online, printed and brought to your first appointment. Please do not email them to me, they contain personal information that is not safe for email.
Filling them out in advance allows us to spend more time together in the first appointment instead of taking the time at our meeting to fill them out.
Please fill out the individual or couple information and the informed consent form. Thank you.
PDF documents
(click to download)
Payment Options
You may make a credit card payment using the button below, or make a direct payment through Zelle.
Credit Card Payments
To make a credit card payment, please click the payment button below. You will receive a receipt by email after your payment has been processed.
AVS Mismatch Error
If you receive an AVS mismatch error, this means that the billing address information entered does not match the information your bank has on file for the credit card. Please check that your address and ZIP code are entered exactly as they appear in your bank’s records.
If you experience any difficulties using the credit card payment system, please contact me.
Important: When making a payment by credit card or Zelle, please indicate in the description/memo section the date the payment should be applied to. If you are paying for the entire month, please indicate the month the payment is for.
