Client Intake Forms

If your therapist has directed you to complete our "online forms" you will find them below. However, your therapist may have their own specific registration and intake forms for you to complete, which you can find here on their individual pages. 

Carolyn Dehnbostel                                  Bryan Kingsriter                                      Cindy Frederick

Christine Hunter                                        Vessela Kouneva                                         Jay Lampert

Bev Stratton                                           Nancy Dawn Van Beest                                   Kevin Kelly

Kurt Wical

 

Intern: Sarah Anderson
Intern: Sergio Vucci

 

If your therapist has directed you here, please download these forms, fill them out, and bring them with you to the initial consultation with your therapist. If you have not received instructions from your therapist, please ask them before using these forms.

Click to download:

Client Registration Form

Client Intake Form

Couples Questionnaire Form

HIPAA NOTICE OF PRIVACY PRACTICES

The HIPAA NOTICE OF PRIVACY PRACTICES, posted in our office or given to you at intake, details the considerations regarding confidentiality, privacy, and your records. Periodically, the HIPAA NOTICE OF PRIVACY PRACTICES may be revised. Any changes will be posted in our office, but you will not receive an individual notification of the updates. It is imperative that you read and understand the limits of privacy and confidentiality before you start treatment.