This New Client Packet is required to be completed before starting our first session. Please print out and complete all of the documents in their entirety before coming to your first session. Included in this packet is a personal information form, consent for treatment, notice of privacy practices and HIPPA regulations, client rights, my professional disclosure statement, and financial agreement.


The information in this questionnaire gives me a better understanding of your history, your current situation and helps me to understand the circumstances that have brought you to counseling. Please complete this form as honestly and completely as possible. All information that you provide is confidential.


Youth Intake Questionnaires

Parent Form

Youth Form

 

 

The Youth Intake Questionnaires provide me with valuable information that gives me insight into your child's history, their current situation and helps me understand the circumstances that have brought them to counseling. The Parent form should be completed by at least one parent or guardian. If the child/youth is old enough to complete the Youth Form on their own, please have them complete the form without influence. To protect your child's privacy, you can seal their completed form in a separate envelope.