Intake Paperwork
Many clients choose to simply come in 15 minutes
early for their first appointment and fill out paperwork at the
office. However, if you'd like to save yourself a few minutes you can download the paperwork below and fill
it out prior to coming for your first session.
Please note that if
you're a returning client and it's been 6 months or longer we will need you to fill out intake paperwork again. If
you are under the age of 18 you will need a parent to fill out the paperwork and sign the consent for
treatment.
Privacy - Please know we are bound by our ethics and federal law to protect your confidentiality. We
will not disclose any of your information to any person or outside agency without your permission. If you
print off and fill out paperwork prior to your first session, it 's your responsibility to keep that information
private until you give it to us to enter in your chart. There is only one time we can break confidentiality
and that is if we perceive you are a harm to yourself or another.
Simply
right-click on a link below and choose to save a copy to your computer for printing
Intake
Form - All new
clients fill this out. Families and couples choose who you want the chart name to be in.
Child Checklist
Form - If your child is the client, this form is in addition to the other paperwork
above.
Notice of Privacy Practices - This is for you to keep. Please print a copy for
yourself.
Couples
Intake Forms - Each partner needs to fill out a copy of the forms below, in
addition to filling out one of the Intake Forms above.
- 17 Areas
Evaluation
- Current
Marital Status
- Enjoyable Conversations
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