Intake Forms

Required 24 hours prior to your appointment with any clinician at our office. Includes:
- Information and Consent Form
- Fee Agreement & Late-Cancel/No Show Policy
- Notice of Privacy Practices
- Client Information Form
- Client Contacts Form
- Client Insurance Form
- Payment Authorization Form
- Client History Form

If you are working with a Supervisee in Social Work, Resident in Counseling, or an intern, please all fill out their specific consent form.

Please fill out this consent form if you will be working with Eli Mick, Supervisee in Social Work.

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Please fill out this consent form if you will be working with Hayley Jenkins, Supervisee in Social Work.

Please fill out this form if you will be working with Kevin Salvas, Supervisee in Social Work.

Please fill out this consent form if you will be working with Jacquie Shires, Resident in Counseling.

Please fill out this consent form if you will be working with John Bitsas, Supervisee in Social Work.

Please fill out this form if you are working with Molly Haynes or Fatima Batool, Social Work Interns.