Forms

Thank you for your care in completing and reviewing this information prior to your first session.

1. Please complete the appropriate intake information (Adult, Teen, or Child). You may sign the Consent for Treatment during your first appointment.

2. Please thoroughly review the Information for Prospective Clients packet. We realize this document is lengthy. We are required to include all of this information by the mandates of federal privacy legislation, certain insurance requirements, and our ethical and state guidelines. We will review this with you in our first session and answer any questions you may have.

New Clients:

  • Adult Client Information:
    Fillable PDF
  • Teen Client Information:
    Fillable PDF
  • Child Client Information:
    Fillable PDF

  • Information for Clients:
    Open PDF
  • Agreement for Parents*:
    Online Form
  • Consent to Participate in Tele Behavioral Health Counseling:
    Online Form
  • *Please complete the 'Agreement for Parents' form for minor clients with parents not residing in one home.
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  • Zoom Instructions for Clients:
    Open PDF


Other Forms:

  • Authorization for Release of Information:
    Online Form



Checklist for your first appointment

Completed : Forms

  • Adult Client Information or
  • Teen Information or
  • Child & Adolescent Client Information
  • Agreement for Parents : This form is required for minors not residing in one home with both parents.

We will also need:

  • All insurance cards if you will be using health care benefits.
  • Co-Pay or Payment. Checks may be made payable to Counseling Associates.
  • Relevant school and health records.
  • Documentation of parenting plan in case of minor not residing in one home with both parents.
  • Completed Authorization for Release of Information for any individuals or agencies with whom you wish our office to coordinate services (e.g. school, medical providers). Also, please complete this form for any previous counselors with whom you or your child has worked.

  • Submit a photo of the front and back of you insurance card