Client Forms
BRIGHTON OFFICE
All intake forms will be sent to you through our secure, HIPAA compliant electronic health record once your intake appointment is confirmed.
All intake forms will be sent to you through our secure, HIPAA compliant electronic health record once your intake appointment is confirmed.
OKEMOS OFFICE
Adult intake packet - all forms are required for intake.
| Adult Assessment (Fillable).pdf |
| Consent to Treatment (Fillable).pdf |
| Electronic Communication Consent (Fillable).pdf |
| Credit Card Authorization (Fillable).pdf |
| Demographic Face Sheet (Fillable).pdf |
Child/Adolescent Intake Packet (All documents are required at intake)
| Child/Adolescent Assessment (Fillable).pdf |
| Consent to Treatment (Fillable).pdf |
| Electronic Communication Consent (Fillable).pdf |
| Credit Card Authorization (Fillable).pdf |
| Demographic Face Sheet (Fillable).pdf |
| Child/Adolescent Therapy Contract (Fillable).pdf |
| Confirmation of Legal Custody (Fillable).pdf |
Reciprocal Release of Information
| Release of Information , version 1 (Fillable).pdf |
| Release of Information, version 2 (Fillable).pdf |