Forms

Please complete the appropriate forms before your first appointment.

To help us make the most of your first session, please download, complete, and bring the following forms to your appointment. If you have any questions about which forms apply to your situation, don't hesitate to contact us.

New Client Intake Forms

New Client Intake Form

General information about the child and family, reason for referral, and developmental history.

Download

Consent for Treatment

Authorization for therapy services and acknowledgment of office policies.

Download

HIPAA Privacy Notice & Acknowledgment

Your rights regarding the privacy of your health information.

Download

Insurance & Financial Forms

Insurance Information Form

Please provide your current insurance details so we can verify your benefits.

Download

Financial Agreement

Outlines fees, payment expectations, and cancellation policy.

Download

Divorce & Mediation Forms

Mediation Intake Form

Background information for families seeking divorce or separation counseling and mediation services.

Download

Consent for Mediation Services

Authorization and agreement for Family Court Mediation services.

Download

Need Help?

If you are unable to download or print the forms, please arrive 15 minutes early to your first appointment and we will provide paper copies. You may also contact us at (803) 487-1119 or [email protected].