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Helpful forms 

Please complete the form(s) below by clicking on the name of the form. 

You will fill out all forms online and submit them to our HIPAA compliant server. 

STEP 1: Intake Information

These forms provide personal information, insurance information and financial information necessary to set up a clinical and billing account.  


Adult Intake Form


Child & Teen Intake Form


*Couples Intakes
Please complete TWO adult intake forms.

Complete when two adults are seeking counseling for relationship issues

STEP 2: *Office Policies, Informed Consent, and  Protecting the Privacy of Your Healthcare Record

This is a necessary form that contains information about the office and protecting your privacy.  

Please print the above form out for yourself for reference. You will not need to submit this form. Your signature on the Adult or Child Intake Form acknowledges that you have received this form.  


STEP 3: Telehealth Consent Form 

Telehealth Consent Form


Other Forms You May Need:

Release of Information


This form allows your provider to communicate with others involved in your or your child’s care.

Occasionally, you may be instructed to complete additional forms or tests needed in the course of your evaluation and treatment. Your therapist will speak with you about these forms and tests. 

Susanne Hutton, Office Manager

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