Forms

For your convenience, we’ve provided the following forms for you to review, print and complete prior to your first session.

 

 

Confidential Intake Form (PDF)

The confidential intake form is used to help your counselor better assist you. Please answer the questions honestly and openly. The information you provide is confidential and will only be seen by your counselor. This form must be signed and completed prior to you first counseling session.

 

 

Informed Consent For Counseling (PDF)

In order to be fully informed about the counseling you will be receiving, please read through the informed consent agreement. This form must be signed and completed prior to you first counseling session.

 

 

Sliding Fee Scale (PDF)

This is a very confidential process where only the administrator reviews your information, the amount of assistance is determined by family size and household income. Anyone interested in using the sliding fee scale should complete this form prior to your first session.