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  • Home
  • About
  • Telehealth
  • Services
    • Counseling & Workshops >
      • Individual Counseling
      • Couples / Family Counseling
      • Groups/Workshops
    • Crime Victims Compensation Funding
    • Employee Assitance Programs (EAP)
    • PRO BONO >
      • College Students
      • New Immigrants
    • College Student Counseling
    • Substance Abuse Professional (SAP) Evaluations
    • Supplemental Letters
  • INFO
    • RATES/INSURANCE
    • FAQ
    • FORMS
    • POLICIES
    • Opportunities
  • Blog
  • Contact

FORMS

DOWNLOADABLE FORMS


As a convenience to our clients and colleagues, we have made available certain client forms used by our office.
DO NOT SUBMIT THESE FORMS TO US ELECTRONICALLY. 
CLIENT SHOULD BRING INTAKE FORMS WITH THEM TO OUR OFFICE.

INTAKE FORMS


Save time when you visit our office by downloading and completing our intake forms.
Complete these forms in the comfort of your own home, instead of our waiting area.

Intake Form
ince_counseling_intake_form.pdf
File Size: 536 kb
File Type: pdf
Download File

Authorization to Release
authorization_to_release.pdf
File Size: 180 kb
File Type: pdf
Download File

Biopsychosocial Form
biopsychosocial_form.pdf
File Size: 418 kb
File Type: pdf
Download File

Credit Card Authorization

​                                                          Consent to Treat                                                       
credit_card_auth.pdf
File Size: 84 kb
File Type: pdf
Download File

consent_to_treat_form__2020_.pdf
File Size: 250 kb
File Type: pdf
Download File

CRIME VICTIMS INVOICE FORM


Completed by providers on behalf of crime victims or the family members of crime victims.
Crime Victim Invoice Form
crime_victim_invoice_form.pdf
File Size: 158 kb
File Type: pdf
Download File

REFERRAL FORM FOR MENTAL HEALTH SERVICES


 Used for patient referrals . Referring party should make sure to have patient complete the authorization to release form. Please send a copy of the  authorization to release form, along with discharge summary, or recent psychological/psychiatric evaluation with this referral form to us.
Referral Form
refferal_form.pdf
File Size: 138 kb
File Type: pdf
Download File

Authorization to Release
authorization_to_release_form.pdf
File Size: 219 kb
File Type: pdf
Download File

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 All appointments must be cancelled with 24 hours advanced notice or a $75 cancellation fee will be incurred.
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