Below are links to various forms that are used throughout the intervention.  While they seem lengthy, it is often very important that we have complete and varied information.  Remember any time you spend filling out these forms, saves later time and costs seeing a therapist.

They are provided as Adobe Acrobat files, so Acrobat reader will be needed. 

Instructions for intake forms:  Please fill out this form to the best of your ability.  Some sections may not be applicable and you may simply indicate on the form.  Remember that some things that do not seem necessary to you, may be very important to us.  If you do not answer all the questions needed, we may have you answer in session.  You may also want to print out and fill out an “Exchange of Information Form” for any past therapists you may have seen, the professional that referred you and/or anyone else with whom we may need to talk.

Each intake packet has four sections:

                  1) The requested information (several pages)

                  2) A medical checklist

                  3) A three page Informed Consent.  The business agreement (initials and signature required).

                  4) HIPPA forms

Intake Forms


Used when seeing a child, adolescent or teenager.  We also need this filled out before our first meeting.


This form is used when an adult or couple is coming to counseling. If you are being seen as a couple, we need each of you to fill out a form.


There is a lot of information that is needed.  If the adolescent or teenager can fill out this form before coming in, it will save time.

Informed Consent & HIPPA

This is the contract between us.  It explains the office hours, fees, as well as confidentiality issues. This is required before you begin therapy and is part of the above intake packets. 


As part of confidentiality, we cannot talk to anyone without your consent.  This form allows us to talk to anyone you think we need to.

Baseline behavior check list


Chore List