Schedule Appointment

---

Child and Adolescent Forms

Instructions:

Click on the links below to print each form.  Complete the forms and bring them to your first counseling session.
​

1. Child Information Form - To be completed by a parent or guardian for all children and teenagers who will be attending counseling
2. Adult Information Form - To be completed by all teenagers ages 15-17 who will be attending counseling 
3. Declaration Statement - To be signed and initialed ​by all adults attending counseling sessions. A separate form should be signed by a parent or guardian for each child or teenager attending counseling.
4. HIPAA Privacy Notice - To be reviewed by all adults attending counseling sessions (This is to be kept for your records and does not need to be brought to the counseling session.)
5. HIPAA Privacy Notice Signature Form – To be signed by parents or legal guardians
6. Online scheduling and Appointment reminder form – Complete to schedule online and to receive appointment reminders