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Counseling Forms


Print, fill out and bring to your first counseling sessions the correct form or forms listed below.

In addition, review the Informed Consent document. If you do not have access to a printer, let me know by email or phone, so that I can have copies available—so that you can come to the session twenty minutes early in order to fill in the forms.

For Individual therapy
Use this form (if adult or an older child)
Or, at parents’ discretion preteen or younger child use this form
Informed Consent – review only
And parents fill out this form for minors (17 or younger)

For Couples counseling
Each one fill out this form
Informed Consent – review only

For Family counseling
Each adult fill out this form
At parents’ discretion, older child can use this same form
Or younger child can use this form

Informed Consent – review only
And parents fill out this form for minors (17 or younger)

Please double-check before you come to the first session.

  1. You should have reviewed the Informed Consent document.
  2. Everyone who will attend sessions should have filled in a version of the Client Information form.
  3. Parents will fill in an additional form for a client who is a minor.
  4. If client is a minor and parents are divorced, bring along the custody agreement, unless both parents will be present in the introductory meeting.

Another form that may be useful. Print out and fill in if a consultation with another health professional (for instance, psychiatrist, former therapist, neurologist, or other attending physician if a medical issue is part of the reason for seeking counseling).

Authorization to Release Protected Health Information (which allows counselor to speak to someone else about the client)