Consent form

I _____________________________ hereby authorize _____________________________ (therapist)

of _____________________________ (city/state) to release any and all information contained

in the record of _____________________________ (patient’s name) to Evergreen Psychotherapy Center for professional use only.

This consent will expire on _____________________________ (mm/dd/yyyy).

Signed: _____________________________

Relationship to patient: _____________________________ (parent, self, etc.)

Witness: _____________________________

Date: _____________________________

 

Credit card type (Visa or MasterCard):

Credit card number:

Expiration date:

Name as it appears on the credit card:

Upcoming Seminars

Dr. Terry Levy travels the world to deliver professional training and instruction for general audiences. Here’s where to find him next. Visit our calendar for full details:

January 29
Woburn, MA
January 30
Waltham, MA
January 31
Dedham, MA

February 27
Marietta, GA
February 28
Decatur, GA

March 27
Albany, NY
March 28
Springfield, MA
March 29
Poughkeepsie, NY

April 16
Dallas, TX
April 17
Plano, TX
April 18
Oklahoma City, OK

May 30
Ann Arbor, MI

Visit our calendar for more details.

What is attachment?

It is the deep and enduring connection established between a child and caregiver in the first several years of life. However, more and more children are failing to develop secure attachments to loving, protective caregivers. These children are left without the most important foundation for healthy development and are at risk for:
  • low self-esteem
  • lack of self-control
  • antisocial attitudes and behaviors
  • aggression and violence
  • lack of empathy, compassion and remorse
Read more.

Recommended reading

These books and journal articles explain the most important aspects of attachment in adults and children, child maltreatment, treatment approaches, parenting and related social issues.