Forms
Background Check Information
- New Background Check Procedures
- In State Applicant Information
- Out of State Applicant Information
- Privacy Authorization Statement
- Required signature form for Criminal Records Review
Sample Statement and Declaration of Practices and Procedures
- PLMFT Statement of Practices and Procedures
- LMFT Statement of Practices and Procedures
- PLPC Declaration of Practices and Procedures
- LPC Declaration of Practices and Procedures
- LPC-S Declaration of Practices and Procedures
- Teletherapy Addendum
Licensee Forms
- Complaint Form
- PLMFT Documentation of Experience Form
- PLPC Documentation of Experience Form
- Expedited Processing Form
- LMFT Documentation of Supervision of Supervision Form
- Endorsement Applicant License Verification Form
Supervision