COMMUNITY COUNSELING ASSOCIATES
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  • Services
  • Meet Our Therapists
  • Advantages
  • Forms
  • Contact Us

treatment forms

if you are unable to print forms, please arrive 10 minutes prior to your first session to complete paperwork
adult intake 
​please print & fill out intake form below, BRING FORM 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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