Intake Forms

In order to save time and money at your first visit, please print, fill out and sign the following necessary INTAKE paperwork.

FOR COUPLES, Please print and fill out the following 5 forms:

• COUPLES COUNSELING APPLICATION
• COUNSELING INTAKE (print out 2, one for each partner)
• PROFESSIONAL DISCLOSURE
• INFORMED CONSENT
• NOTICE OF WHOLE HEALTH PLUS POLICIES

FOR INDIVIDUALS 16 & Older, Print and fill out the following 5 forms:

• COUNSELING APPLICATION
• COUNSELING INTAKE
• PROFESSIONAL DISCLOSURE
• INFORMED CONSENT
• NOTICE OF WHOLE HEALTH PLUS POLICIES

FOR CHILDREN, Print & Fill Out The Following 5 Forms:

• CHILD COUNSELING APPLICATION
• PARENT/CHILD INTAKE
• PROFESSIONAL DISCLOSURE
• INFORMED CONSENT
• NOTICE OF WHOLE HEALTH PLUS POLICIES

Additional Forms:

• WEEKLY ASSESMENT OF DEPRESSION
• BACH FLOWER QUESTIONNAIRE
• CES-D DEPRESSION SCALE
• LOVE LANGUAGE QUIZ
• NEEDS ASSESSMENT REALITY THERAPY
• CHAKRA TEST
• SYMPTOM CHECKLIST