The following are my forms for Informed Consent:
    please read if you are a new patient

    My business practices informed consent
    Teletherapy informed consent     (for therapy by video or phone)

    Psychotherapy sessions are offered on a fee for service basis and I ask that you pay at the time of each session. I do not work with any insurance companies and I will provide you with a billing statement to submit to your insurance provider, if you request this.

    A good faith estimate of the cost of therapy is available prior to the start of treatment.
    I will discuss fees with you when we discuss my services and arrange for an appointment.

    ​My phone number (650-781-6881) will not be in service until mid July 2022
               Please email me at [email protected] 

                You may also use the form below to contact me:

My office address is:
Moby R. Coquillard, LMFT
1777 Borel Place, Suite 214
San Mateo, CA 94402
Moby R. Coquillard, LMFT
1777 Borel Place, Suite 214
San Mateo, CA 94402

Directions from North or South 101: Take Highway 92 West to El Camino North.  Go straight on El Camino to Borel Avenue and go left.  Continue to Borel Place and turn left.  1777 Borel Place will be straight in front of you, just behind the grove of Redwood Trees.  The entrance is right in the front and my suite is 214, on the second floor.

Directions from North or South 280:  Take Highway 92 East to El Camino North.  Go straight on El Camino to Borel Avenue and go left.  Continue to Borel Place and turn left.  1777 Borel Place will be straight in front of you, just behind the grove of Redwood Trees.  The entrance is right in the front and my suite is 214, on the second floor.