COMMUNITY COUNSELING ASSOCIATES
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  • Home
  • Covid-19 Procedures
  • Services
  • Advantages
  • When to Seek Counseling
  • Meet Our Therapists
  • Forms

treatment forms

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

INFORMED CONSENT FORM

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

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

child intake form

Fee agreement
please print & sign the agreement below.

fee agreement form

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

credit/debit/hsa form

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

notice of privacy practices form

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

privacy practices acknowledgment form
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