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Counseling Services

Individual Therapy
Couples & Family
Assessment
Personal Growth and Wellness
Parenting Support
Stress Management

African American Mother with Daughter
African American Boy

Click HERE for our comprehensive plan to keep our offices safe and therapeutic. We are still offering teletherapy from the comfort of home. Click here for instructions on our teletherapy platform, Google Meet. E-sign a Consent For Teletherapy Form too!

Forms

Please click on the blue link to complete the applicable paperwork.

Teletherapy:

Consent For Teletherapy Form

<link rel="stylesheet" type="text/css" href="https://www.pdffiller.com/css_v2/link2fill-0.1.min.css"> <a href="https://pdf.ac/41Co0v" target="_blank" title="PDFfiller.com: " style="color:#242e25;background:#46ce38" class="pdffiller-fill-form-btn">Fill Online</a><div class="pdffiller-clr"></div><link rel="stylesheet" type="text/css" href="https://www.pdffiller.com/css_v2/link2fill-0.1.min.css"> <a href="https://pdf.ac/41Co0v" target="_blank" title="PDFfiller.com: " style="color:#242e25;background:#46ce38" class="pdffiller-fill-form-btn">Fill Online</a><div class="pdffiller-clr"></div><link rel="stylesheet" type="text/css" href="https://www.pdffiller.com/css_v2/link2fill-0.1.min.css"> <a href="https://pdf.ac/41Co0v" target="_blank" title="PDFfiller.com: " style="color:#242e25;background:#46ce38" class="pdffiller-fill-form-btn">Fill Online</a><div class="pdffiller-clr"></div>New Client Paperwork:
If you're a new client, please complete the following forms and bring them to your first therapy session. The below forms serve as a consent for treatment. DO NOT date as we will do this then. Please bring your insurance card and photo ID to your first appointment.

Client Intake Paperwork

Yearly Paperwork:

New Calendar Year? Please complete any of the below forms.

Consent For Treatment Form

Completing a Release of Information:

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, school personnel etc.), complete this form to authorize the release or receiving of information. (Note: we must have a release of information form on file for EACH individual that you would like us to contact)

Release of Information Form (to share information upon request)

Other Forms:

To complete a form so that your credit card can be safely kept on file, please complete the below form.

Credit Card Authorization Form

Please complete below form for the DBT skills program participation.

DBT Consent Form

Confidentiality & Privacy Policy

The law protects the relationship between a client and a therapist, and information cannot be disclosed without written permission.

Exceptions include:

  • Suspected child abuse or dependent adult or elder abuse, for which we are required by law to report this to the appropriate authorities immediately.
  • If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
  • If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, we will take further measures without their permission that are provided to us by law in order to ensure their safety.


Note: To download Adobe Acrobat Reader for free, click here.

 

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE