New Clients
After you have requested an appointment through the form at the bottom of this page, you will be contacted by our office manager or your potential new counselor. They will assist you set up with your next steps in starting therapy. If you set up an appointment with your counselor, they will let you know which forms you will need to complete. Normally, the forms are sent through our online client portal. Ask your counselor for details.
Our intake forms are also available to the right. Simply print, complete, & bring the appropriate forms to your first appointment. If you have scheduled an online appointment, you can mail the forms to our main office:
700 Frederick St. Suite 103
Santa Cruz, CA 95062
If you do not have access to a computer, or the if you are not familiar with the technology, please arrange to arrive early for your first appointment to complete paper copies of the forms. Your counselor can leave them for you in the waiting room. Please allow approximately 30 minutes to complete the paperwork. Thank you!
Pay Now (if you need to make a payment yourself)
Print these forms if you cannot use the Client Portal. Return your signed copy to your counselor by paper, fax or email.
For All Clients:
- New Client Information Form
- Consent For Services
- Client History Form (Adults Only. For Youth, Use the Youth Versions)
- Payment Authorization
- Insurance Information
- Notice of Privacy Practices
- Release of Information
- Important Contacts Form
Special Forms for Children or Teens:
Special Forms for Couple/Family or Group Therapy:
Fax Your Forms:
831-417-0443
Request an Appointment
To Request an Appointment at Shine a Light or NPCC, please fill out this form. We respond to inquiries Monday through Friday. All inquiries we receive on the weekends or holidays will be processed the next business day. Thank you for your patience. If you need immediate services, please call 911.
Agency Inquiries
New Office in San Francisco!
Shine a Light Counseling Center is please to merge with New Perspectives Center for Counseling. NPCC has been serving the San Francisco community for thirty years. Now NPCC is transitioning to become the San Francisco site for Shine a Light. NPCC will retain its name, character and history. For information about NPCC or counseling in San Francisco:
New Perspectives Center for Counseling (link)
Emergency Contact
Shine a Light does not provide crisis services. If you have a mental health emergency, call 988 or 911. Or click here for more Crisis Resources
Telephone Contact
You can call Shine a Light at 831-996-1222, but we encourage you to use the email forms to the left. If you call, please leave the following:
- Phone number
- Preferred location
- Best times to meet
- Issue you want help with
- What insurance you have (if any)
FAX us at: 831-417-0443
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your therapy sessions will cost. Your fee will be set according to a sliding scale, in collaboration with your therapist, prior to your first counseling session. Total costs depend upon the number of sessions you choose to utilize.
If you have private health insurance and we are not in-network with your plan, please be aware that your costs for therapy may be less by using an in-network provider. This will depend upon your plan's deductible amounts and co-payments. In some cases, counseling at Shine a Light is less costly than using private insurance.
If you hope to use "out of network" benefits through your private insurance, please be aware that many plans will not reimburse for services provided by trainees. Please request an Associate level therapists for out-of-network billing.
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