Child, Individual and Family Counseling

Help and Support for Times of Transition

Forms for use in Counseling


It will save time during our initial session if you read and complete the documents listed below. Please click on each of the following documents. Be patient, it may take several seconds to open each file.  Complete each form using Microsoft Word and save it on your computer, making a note of the location where you save it.

Consent for Treatment

Professional Disclosure Statement

Privacy Practices Consent Form 

Demographic Information  

Counseling Goals

Prepare an email message to me at this address:

Attach the completed forms to the email and send.


Insurance Reimbursement

We do not accept insurance reimbursement directly, or process insurance claims.  We can provide a coded invoice that you can forward to your insurance carrier.