top of page

Minor Consent Form

STEP 1

Fill Out Form

Please fill out the form below to the best of your abilities.

You can either:
    a. Fill out electronically and download
    b. Fill out electronically and print it
    c. ​Print and use pen to fill out
STEP 2
Return Completed
 When you've filled out the form:
  1. Download the file to your computer with your inputs (⤓ icon)
  2. Send the completed form as an email attachment to hello@AffirmativeCounselingCenter.org
  3. When sent, delete the email from your sent folder for added security

* If printed or filled out by hand, please return it in person or by mail to 5919 W 3rd St, Ste 1E, Los Angeles, CA 90036.

Please fill out the form on a laptop or desktop. Not compatible on mobile, or in Apple Preview. Thank you for your understanding!

© 2025 Affirmative Counseling Center. All Rights Reserved. LMFT 48870.

Affirmative Counseling Center

5919 West 3rd Street, Suite 1E

Los Angeles, CA 90036

Gay Owned and Operated

bottom of page