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Pursuant to the Federal Trade Commission's Red Flags Rule, we must request a copy of your insurance card (if applicable) and a copy of a government issued photo ID (such as your driver’s license). Please bring these items to your first session.
New client paperwork for adults (please print and complete):
Client Self Report Form
Counseling & Fee Policy
Consent Form
Privacy Notice
New client paperwork for children and adolescents (please print and complete):
Developmental Questionnaire
Counseling & Fee Policy
Consent Form
Privacy Notice
If you would like to be on our mailing list, please complete this form.
If you would like these forms mailed to you, please contact us at 717-560-9969.
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