Counseling Forms
Please review below appropriate forms you will sign at your first appointment.
You may also print & complete the "self-report(s)" to provide helpful information to your therapist for your initial meeting.
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Adobe Formatted Forms for First Appointment
Click to open Adobe formatted copies of CFLC forms for your first appointment.
(Download adobe acrobat reader)
For Adults Only
- Practice Disclosure and Consent for Treatment
- Intake Information Forms for Adults
- History and Concerns Self Report
- Insurance Information Form (only if you plan to use insurance)
- Self-Pay Financial Agreement (only if you will not be using insurance).
OR
For Kids/Teens Only
- Practice Disclosure and Consent for Treatment
- Parent-Child Agreement for Child/Adolescent Treatment
- Intake Information Forms for Children/Adolescents
- Child/Adolescent Self-Report (for child to complete)
- Parent Child/Family Self-Report (for parent to complete)
- Insurance Information Form (only if you plan to use insurance)
- Self-Pay Financial Agreement (only if you will not be using insurance).
OR
May Be Needed in Some Cases
- Authorization to Release Mental Health Records/Information
(if there are provider(s) or family member(s) you want to give me permission
to contact or have involved in your treatment regarding mental health issues). - Authorization to Release Substance Abuse Records/Information
(if there are provider(s) or family member(s) you want to give me permission
to contact or have involved in your treatment for substance abuse issues only).
"If you don't like something, change it; if you can't change it, change the way you think about it "
