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Licensed Supervision for Counselors
Peer Consultation for Licensed Psychotherapists
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Psychotherapy Forms

Intake Form

Informed Consent

Financial Ledger

Personal Status Inventory

Personal Health Questionnaires

Assessment and Diagnosis

Progress Note and Treatment Plan

Release of Information Authorization

Discharge Summary

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Supervision Forms

Agency-LCSW Agreement

ACSW-MFT Intern Agreement

ACSW-MFT Supervision Addendum

Clinical Supervision and Professional Development of the Substance Abuse Counselor, SAMHSA

Learning Plan

ACSW Tracking Log

2015 BBS Supervisory Plan

BBS MFT Intern Tracking Log

BBS MFT Intern Responsibility Statement

BBS ACSW Responsibility Statement

Code of Ethics



Psychodynamic Psychotherapy

Individual Therapy and Relationship Counseling is for adults coping with anxiety, depression, relationship difficulties, past trauma, as well as loss and grief. You have benefited from prior efforts, and you want to address matters that reappear.

Victor Bloomberg, LCSW - Lic. LCS 15746
Office: 5252 Balboa Avenue, Suite 803, San Diego, CA 92117
Mail: P.O. Box 3483, San Diego, CA 92163
Phone:(858) 252-4740