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Adult Intake Forms

For new adult patients, please print and fill out all forms and bring to your therapy session. If you are attending couples counseling, one of each form needs to be completed with the exception of the insurance/billing forms.

Services & Policies

HIPAA Signature Page

Adult Consent to Treat Form

Childhood Experience Questionnaire

Symptom Measure Questionnaire

Intake Questionnaire

Financial Policy

Insurance Benefits Worksheet

Billing-Insurance Form

Appointment Reminder


Couples Questionnaire - only if you are attending couples counseling

Release of Information - Only if you would like us to share information or records with another person


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If this is an emergency please contact 911

LOCATION

Appointment Times

Monday:

8:00 am-7:00 pm

Tuesday:

8:00 am-8:00 pm

Wednesday:

8:00 am-8:00 pm

Thursday:

8:00 am-7:00 pm

Friday:

8:00 am-5:00 pm

Saturday:

8:00 AM-12:00 PM

Sunday:

Closed