Forms for New Clients
There are several standard forms that we ask each new client to complete:
Contact Information Form. This form provides us with your contact information and allows you to specify how you would like to be contacted in the future by Holistic Mental Health Services.
Informed Consent and Authorization for Services Form. This form summarizes important information about confidentiality, fees, cancellation policies, and other practices and policies of Holistic Mental Health Services. Please review it, initial where necessary, and sign page 7.
Intake questionnaire. The purpose of this questionnaire is to aid assessment and treatment planning by giving your professional partner a broad overview of your background and current situation at a glance. All information you provide in this form will be kept as part of your confidential file.
It should take about 30 minutes to complete these forms. So that we can spend your session time focusing on your concerns and not paperwork, we prefer to have you fill them out ahead of time, before the start of the first session. If you are coming as a couple, each spouse should fill out the complete package listed above.
Clicking on a link below will open a PDF version of these forms. Then you can print the forms directly to your printer, complete them at home, and bring them with you to the first appointment. If you are an online therapy client and have access to signing the forms with an electronic signature to submit prior to your initial appointment. The forms can also be sent via email to firstname.lastname@example.org or fax to (305) 675-7882.
CLICK ON A BUTTON BELOW TO DOWNLOAD INTAKE FORMS
Please select one of the categories below that most pertains to your situation and click on the link in that box to open the intake forms.