CHILD/MINOR INTAKE FORM
Thank you for considering us for your counseling needs.
To request an appointment we'll need some information from you to get started. Please complete our new client form to save time during our first session.
At the beginning of our first session, our therapist will briefly review the information sheet to make sure I have all information required for my records. We will also explain our policies regarding confidentiality and fees associated with your therapy. Please ask us any questions you have about therapy; as we are here to serve you and to make you comfortable during this process. If you would like a copy of our HIPAA Privacy Practices you can review them here.
Appointment Time Preferences
PLEASE SELECT TWO (2) THERAPIST OPTIONS FROM ONE (1) CATEGORY BELOW
CATEGORY 3 - Trainee/Intern