PATIENT FORMS
The Family Connection
PATIENT FORMS
PROVIDING Connections
Intake Forms
If you’re a new client, 18 years and older, please complete the following forms and bring them to your first therapy session.
NEW PATIENTS SEEKING COUPLES COUNSELING
If you are a new patient seeking couples counseling, each partner will need to complete this form individually and bring it to your appointment. Please do not share your answer!
NEW PATIENTS SEEKING FAMILY COUNSELING
If you are a new patient seeking family counseling, please complete the following forms and bring to your first appointment. Please print one copy of Part 2 packet per family member!
NEW PATIENTS AGES 14-18
If you are a new patient with a child between the ages of 14-18, please complete the following forms and bring to your first appointment
NEW PATIENTS AGES 12-13
If you are a new patient with a child between the ages of 12-13, please complete the following forms and bring to your first appointment
UNDER THE AGE OF 12
If you are a new patient with a child under the age of 12, please complete both forms and bring to your first appointment.