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Below you will find links to the Client Intake Form, Client Consent and Release, and Release of Information

You may complete these forms online. 

If you prefer to use paper documents, PDF versions of the necessary paperwork are beneath (click the buttons to open the documents)

We look forward to meeting you at your first appointment! 

PDF INTAKE FORM

PDF CONSENT FORM

The above are MANDATORY FORMS

The Intake Form and Consent Form are the two primary and mandatory documents for your first appointment. Please note that these documents must be completed fully and throughly and all signatures must be present where indicated for treatment to proceed. Please feel free to print these documents and complete them prior to your first appointment. 

The Sliding Scale agreement for reduced counseling fees is for eligible uninsured parties who are able to provide proof of income.  

PDF RELEASE OF INFORMATION

The Release of Information is a document needed to release information to any party not indicated on the consent form. This might include lawyers, doctors, courts, family members, etc. A separate version of the release of information is needed for each separate party or entity for which information should be released. 

PDF CLIENT SURVEY

The Client Survey is a voluntary form that you may fill out and email to the director at [email protected] to rate your satisfaction with the services you have received. We also have copies at the office you may utilize.