If you're a new client, please complete the appropriate set of intake forms and bring them to your first therapy session.
Forms for Counseling:
- Therapy Intake forms for Children & Adolescents
- Therapy Intake forms for Adults
- Therapy Intake forms for Couples
Forms for Medication Management/Psychiatry:
- Psychiatric ADULT Intake forms for Dr. Syeda Younus
- Psychiatric ADOLESCENT Intake forms for Dr. Syeda Younus
- Psychiatric ADULT Intake forms for Sara Hagen, PMHNP
- Psychiatric CHILD & ADOLESCENT Intake forms for Sara Hagen, PMHNP
- Psychiatric Intake forms for Jennifer Allran, PMHNP
Forms for Psychological & Academic Evaluations:
- Intake Forms for Children/Adolescents
- Intake Forms for Adults
- Psychological Testing Packet
- How to Get the Most out of Psychological Testing
If you are an existing face-to-face client needing to consent to online sessions, please print, sign, and email this form:
Provider specific Professional Disclosure Forms for our Licensed Clinical Mental Health Counselors:
- Brooke Trimble Kzros: https://hipaa.jotform.com/202978386488072
- Colleen Lennon: https://hipaa.jotform.com/202988066488169
- Jessie Condon: https://hipaa.jotform.com/202078537077055
- Charlie Stiles: https://hipaa.jotform.com/202988344290058
- Brooke Harris: https://hipaa.jotform.com/203027640588052
- Amy Benton Moulds: https://hipaa.jotform.com/202078652678060
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