New Client Forms

For your convenience our forms are available for you to print and complete at home. If you would prefer to fill these out at the office, please arrive 30 minutes prior to your first scheduled appointment. As always, if you have any questions or concerns, please contact us and we would be happy to assist you. We look forward to working with you.

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Welcome Letter

*Please complete one copy of each form listed below. If more than one individual will be receiving counseling, please complete one form for each person.

Treatment Consent Form

Protected Health Form

Fee Agreement

Medications

Emotional Symptoms Checklist Adults

Health Screen Adults

*Please complete the forms below if the individual being seen is a minor

Parent-Guardian History (To be completed by parent/guardian)

Physical Health Screen (Ages 4-17) (To be completed by parent/guardian)

Child Self-Report Form (To be completed by children ages 8-12)

Emotional Symptoms (To be completed by children ages 13-17)

 

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