Forms

Adult Intake Form

Necessary paperwork for adults to complete prior to their first counseling session.

Child and Adolescent Intake Form

Necessary paperwork for parents to complete prior to their child's first counseling session.  If more than one child is scheduled for counseling, please print and fill out one form for each child.

Minor Consent Form

This form needs to be completed by the custodial parent or guardian before a minor child (under the age of 18) can be seen by a counselor.

Notice of Privacy Practices

Information about your rights as a client.  The last page needs to be printed, signed, and given to your counselor for your initial appointment.  Parents are asked to sign this form for their minor children.

Release Form

When you need your counselor to speak to another person (teacher, counselor, doctor) in your behalf, this form needs to be signed and given to your counselor.  The counselor then sends it to the person(s) you designate so they can communicate.

Substance Abuse Evaluation

Substance Abuse Evaluation for clients of Jean Smith, LPC.