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    12139 Mount Vernon Ave, Suite 104 | Grand Terrace, CA 92313
    TerraVistaCounseling@gmail.com | (909) 452-5857

  • TaKenya Clark-Jefferies

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    Client Forms

    If you are new to the working with me, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

    Client Intake Form

    Information Sheet

    Limits of Confidentiality

    If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

    Authorization for Release of Information

    Contact Today



    12139 Mount Vernon Ave, Suite 104 Grand Terrace, CA 92313

    (909) 452-5857 TerraVistaCounseling@gmail.com

    Contact Today

    Terra Vista Counseling
    TerraVistaCounseling@gmail.com | (909) 452-5857

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