New Client Intake Forms

Adult, Marital, or Child

Adult Confidential Information Form

Adult client contact, demographic, health, and general information

Child Confidential Information Form

Child client contact, demographic, health, and general information

Marital Confidential Information Form

Marital client contact, demographic, health, and general information

Required Forms

All forms below are required for new clients

Client Service Agreement

Agreement on business policies, client rights, privacy, and more

Notice of Privacy Practices HIPAA

Policies and practices to protect the privacy of your health information

Financial Agreement

Financial authorization for billing and agreement for payment

Acknowledgement of Notification

Acceptance of all required forms, practices, and policies

Additional Forms

Supplemental forms available for download

Authorization to Release

Coordinate care and share information with another provider

Couples Four Horsemen Self Test

Gottman Couples Four Horsemen Self-Test

Couples Problem Areas Questionnaire

Issues to work through in marriage counseling

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