Schedule Appointment

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Couples Forms

Instructions:

Click on the links below to print each form.  Complete the forms and bring them to your first counseling session.
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1. Adult Information Form - To be completed by all adults attending counseling
2. Declaration Statement - To be signed and initialed by all adults attending counseling
3. Couples Release of Information - To be signed by all adults attending couples counseling.
4. HIPAA Privacy Notice - To be reviewed by all adults attending counseling (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 all adults attending counseling