COMMUNITY COUNSELING ASSOCIATES
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Covid-19 Procedures
Services
Advantages
When to Seek Counseling
Meet Our Therapists
Forms
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.pdf
Adult 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