Intake Form
This form is required for all clients seeking counseling. It provides this therapist with general information about the client and their basic contact information.
Consent to Treat a Minor- Parent:
This form is required for clients that are 17 years or younger. This form should be signed by both parents in order to give therapist permission to treat the client.
Heather Young Disclosure Statement:
This form is required for all clients seeking counseling. It is a state mandated disclosure that gives the client information about this therapists qualifications and the clients’ rights within therapy.
Informed Consent:
This form is required for all clients seeking counseling. This form gives the client a detailed description the following;
- The therapeutic process
- This therapist’s education and theoretical orientation
- Fees and payment options
- No show or late cancellation policy
- Emergency protocol
- Benefits and risks to therapy
- Termination of therapy
- Confidentiality
Notice of Privacy Practices:
This form does not need to be signed, but is for the clients’ personal records. This form gives you all the information needed to understand how your records are kept private and how to obtain access to your records.