Counseling Paperwork

Please complete this paperwork before first your session.  You can either email the paperwork back to or you can bring it to your session.

Client Paperwork

Adult Symptom Checklist – Fill in

Complications of the Therapy Process

Treatment Needs

Pick One Consent to Treatment (Self-Pay or Insurance)

Consent to Treatment – Insurance

Consent to Treatment – Self-Pay

Copies for your Records

Emergency Contacts

Notice of Privacy Practices