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Thank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping CartIntake Paperwork Packets
*Click link for specific counselor and note there is an adult or minor option*
Katherine Arnold, LPC-S, LMFT-SC, CRFC
Adult Intake Packet for Katherine Arnold
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms.
Minor (under age 18) Intake Packet for Katherine Arnold
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms. Please be advised that if you share custody of your adolescent, you will need to provide legal documentation that you have primary custody. Otherwise, both parents holding custody rights will be required to sign the Informed Consent prior to treatment.
Couples Consent Release
Information obtained from an adult client individually may NOT be shared with anyone without written consent. Information may be released ONLY with the client’s spouse or other family members with the client’s written permission. Clients may refuse to provide written permission to waive confidentiality rights between or among each other. Please be advised that withholding information from each other during couple or family therapy could impede or even prevent a positive outcome to therapy.
Nicole Barnum MA, RN, LPC, NCC
Adult Intake Packet for Nicole Barnum
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms.
Minor (under age 18) Intake Packet for Nicole Barnum
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms. Please be advised that if you share custody of your adolescent, you will need to provide legal documentation that you have primary custody. Otherwise, both parents holding custody rights will be required to sign the Informed Consent prior to treatment.
Samantha Smith MS, PLPC, NCC
Adult Intake Packet for Samantha Smith
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms.
Minor (under age 18) Intake Packet for Samantha Smith
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms. Please be advised that if you share custody of your adolescent, you will need to provide legal documentation that you have primary custody. Otherwise, both parents holding custody rights will be required to sign the Informed Consent prior to treatment.
Melissa Carson MEd, PLPC, NCC
Adult Intake Packet for Melissa Carson
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms.
Minor (under age 18) Intake Packet for Melissa Carson
The intake form provides me with information about you, your family, history, presenting problem, and associated symptoms. Please be advised that if you share custody of your adolescent, you will need to provide legal documentation that you have primary custody. Otherwise, both parents holding custody rights will be required to sign the Informed Consent prior to treatment.
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