Client Forms

Psychotherapy Forms

For New Clients

ADULTS:

1. Adult Psychotherapy Therapy, Telehealth, & HIPAA Consent Form

2. Adult Intake Information Form

3. Professional Disclosure and Informed Consent (North Carolina Clients Only)

CHILDREN AND ADOLESCENTS:

1. Child & Adolescent Therapy, Telehealth, & HIPAA Consent Form

2. Child & Adolescent Intake Information Form

General Forms

1. Informed Consent for In-Person Services During COVID-19 Public Health Crisis

2. Authorization to Release / Receive Information

3. Sliding Scale Agreement

4. Good Faith Estimate Acknowledgement

Speech Language, Skills Development, & Coaching

COACHING

• Adult Coaching Intake Form

• Family Enrichment Coaching Intake Form

SPEECH, LANGUAGE, AND SOCIAL THINKING

• Pediatric Intake Form

FEEDING AND NUTRITION

• For Infants & Toddlers

• For Children 3-12 years old

• For Adolescents

OTHER

• Child & Adolescent Consent for Therapy Treatment

• Adult Consent for Therapy Treatment

• Educator Questionnaire