Forms

EMERGENCY CONTACT INFORMATION

RESPONSIBLE PARTY

PRIMARY INSURANCE INFORMATION

EMPLOYEE ASSISTANCE INFORMATION

CREDIT CARD INFORMATION ** Note your credit card will only be charged for no shows, late cancelations, or copayments
Please "Submit"

This page is designed to assist our clients prepare for their first session. As part of our intake process we need to collect Personal Health Information (PHI) in order to better understand you and the issue that brings you into counseling. After you complete these forms please bring them with you to your first appointment, if you are having trouble downloading these forms PLEASE FEEL FREE TO CALL THE OFFICE AND WE CAN EMAIL THEM TO YOU.

 

Letter to our clients

 

Contract for Treatment

 

Client-Information

 

Release-of-payment-Information

 

New Patient Information