A Place for Personal Development and Relationship Enhancement.
In helping determine what method of communication you want to employ with us, we need to remind you if you choose to communicate with us via electronic transmission (faxes, cell phone, and/or emails), that, in this day and age of hackers, there is no 100% guarantee of confidentiality for any of us via electronic transmission. However, we’ll do our utmost to preserve your communication’s confidentiality through our security procedures.
Step 1. For New or Returning Former Client’s Appointment Setup:
Please fill out the “Prospective Client Data Form”:
- Option 1 – Click here to fill out the Prospective Client Data Form Online
- Option 2 – Click here to download and complete the Prospective Client Data Form. Then fax or mail.
Step 2. For Clients Who Have a Booked Appointment:
Please choose the relevant forms below, determined by age of the client(s), and, if you are coming in as an individual or as a couple. Download and complete the forms that apply to your situation. Bring them with you to your 1st appointment unsigned and our administrative staff will serve as your signature witness. There is no email return possible for these “1st appointment” forms. Also, please understand that if you do not choose to complete these forms by downloading, you’ll need to come in a half hour before your 1st appointment to finish them.
Adult (18 years+) Client Forms
- Click here for the Adult Payment Form
- Click here for the HIPAA Notice of Privacy Practices
- Click here for the Psychologist- Client Services Agreement
- Click here for the Adult Intake Information Form
Couples’ Client Forms
- Click here for the Couples Questionnaire (In addition to the Couples Questionnaire, each spouse/partner should complete the forms listed under the “Adult” section)
Children’s ( 12 years and up) Client Forms
