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The future depends onwhat you do in the present
African American Couple

Helpful Forms

During you first session you will be ask to read and sign the following forms: All of them with the exception of the (if needed) forms are important to be completed prior to receive services.

  • Client Information Form
  • Service Agreement Form
  • Fee Schedule Form
  • Consent for Counseling and Group Treatment /Services Form
  • Limits of Confidenciality Form
  • Credit Card Authorization Form
  • Parental Consent for Treatment (if needed)
  • Authorization for Disclouser of Health Information (if needed)

Insurance coverage and benefits need to be verifed before your first session, please be ready to provide you insurance information when you call to schedule an appointment.
If you have any questions or concerns regarding the forms above please contact our office.  We will be happy to assist you. Thank you.