Forms 2018-01-25T14:53:02+00:00

Forms for your first visit

You can download forms to bring with you to your first visit and save time in the waiting room. I can always provide them for you when you come, but you may want to come a few minutes early. Just let me know, and I will leave forms out for you!

Intake Forms for Abigail Burd, LCSW
To read and keep for your files: “Notice of Privacy Practices”:
Notice of Privacy Practices_Abigail Burd, LCSW

Update for all forms: I no longer need your social security number. Please leave that line blank.

Please PRINT, COMPLETE AND BRING WITH YOU: “Receipt and Acknowledgment of Notice”:
Receipt Acknowledgment Of Notice_Abigail Burd,LCSW

and “Client Information Form”:
Client Information_Abigail Burd, LCSW.

Optional form that may be useful.
If there is another professional or a family member that you would like me to be able to talk to, this “Release of Information” form may be needed:
Release of Information_Abigail Burd, LCSW

I may ask you to complete one or more of these questionnaires. Please go ahead if you think it is relevant to your case.
Depression screen: PHQ-9
Anxiety screen: GAD-7
If you are pregnant or have a baby under 12 months old: EPDS


Your Name (required)

Your Email (required)

Phone Number


Your Message

By checking this box (required), I certify that I have read this statement and agree to its terms: If you are considering harming yourself or someone else or are in need of IMMEDIATE crisis counseling assistance, please call the San Diego Access & Crisis Line at 1-888-724-7240, 24 hours a day/7days a week. For life threatening emergencies, please call 911. The use of email or this form for communication does not establish a therapist-client relationship. Confidential or time-sensitive information should not be sent through this form.

Burd Psychotherapy
5252 Balboa Ave #803,
San Diego, CA 92117

619 289 7818

Monday  9am – 8pm
Tuesday  9am – 5pm
Wednesday  9am – 5pm
Thursday  9am – 8pm
Friday  9am – 5pm
Saturday  9am – 5pm
Sunday  closed