Janine Jorgensen, LCSW
Therapy for Individuals and Families
​Forms​

When your initial appointment has been scheduled, some forms will need to be completed. Feel free to download the following, and have them completed by your first appointment. They can also be filled out when you come to the office just prior to your scheduled time.
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Authorization for Use and/or Disclosure of Information
HIPAA Notice of Privacy Practices

Location

My practice is situated on Professional Drive and Eureka Road located in the City of Roseville.
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Please enter Professional Drive by taking Eureka Road or Rocky Ridge west from Douglas. Parking is in the back of the
building.
Janine M. Jorgensen
Licensed Clinical Social Worker
2130 Professional Drive #210
Roseville, Ca. 95661
(916)784-3808
j​anine.jorgensen@icloud.com​​
LCS#21245