Forms for your appointment

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Print and complete all of the forms in your category.
Bring the forms to your first counseling session.  

If you are unable to complete the forms before your first visit, please let us know so that we can have the forms ready when you arrive for your appointment. If you choose to complete forms at the office prior to your first appointment, please arrive at least 15 minutes early so that you have adequate time to complete the forms before your session.

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For adults attending counseling as an individual

Adult Forms

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For adults attending counseling for couples

Couples Forms

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For children 14 & under attending counseling

Child Forms

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For teens 15-17 attending counseling

Teen Forms

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For Custody Evaluations

Custody Evaluation Forms

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To be completed if you wish to utilize the cash pre-payment option for counseling

Pre-Payment Form

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Gives consent for Dr. Belaire to communicate with and get records from third party individuals or organizations

Consent to Release Information Form

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Professional code of ethics from the American Counseling Association (ACA) for your review as needed

ACA Code of Ethics

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