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New Client Forms

Adult Forms

Adult Counseling Intake Form

Disclosure Form updated Dec 2021

included in the Disclosure Form are: COVID Precautions Agreement Form for in-person appointments and a Teletherapy Consent Form for virtual appointments.

Notice of Privacy Practices

Credit Card Authorization Form

Client Information Change Form

Release of Information Form

EMDR Therapy Consent

No Surprises Act Disclosure

*If you have a kid or teen in need of services, please contact me to discuss the situation and for appropriate forms.

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