Client Forms

If you are coming in for your first intake appointment with your child, please print and fill out these forms:

  • Client Information and Financial Agreement
  • HIPAA – We only need the signed page. Please keep the notice for your own records.
  • Child History – Please take the time to fill out this form thoroughly so your clinician can get up to speed quickly and best use your appointment time. If desired, each guardian may fill out his/her own copy to provide different perspectives.

 

Additional forms:

  • Authorization of Release – If you would like our clinicians to be able to speak with any other professionals who care for your child (e.g. school counselor, psychiatrist, pediatrician), please fill out this consent form.
  • Group Participation – If you are interested in your child joining one of our groups, please review and complete this Group Agreement form. If you have any questions or are unsure, you may complete it at a later time.
  • Credit Card Authorization – If you would like to have a credit card on file to save time at the reception window, please fill this out.
  • Joint Custody – If there is a joint custody agreement in place for your child, please have all parties fill out and sign this form. The signatures do not have to be on a single sheet.

 

If you are an adult coming in for your first appointment or are otherwise directed to, please fill out this form in lieu of the Child History form: