treatment forms

INFORMED CONSENT DURING COVID-19
PLEASE READ BEFORE ATTENDING AN IN-PERSON SESSIOn.

INFORMED CONSENT FORM

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adult_intake_form.pdfAdult intake 
​please print & fill out intake form below. bring it to your first counseling session.
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Adult intake form

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child intake
Parents, please print & fill out Child intake form prior to first counseling session.

child intake form

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Fee agreement
please print & sign the agreement below.

fee agreement form

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Credit/ debit/ hsa authorization
please print & fill out payment information below.

credit/debit/hsa form

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notice of privacy practices
please carefully read the notice below REGARDING your personal health information.

notice of privacy practices form

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privacy practices acknowledgment & receipt
please sign acknowledgment below after reading the privacy practices notice form.

privacy practices acknowledgment form