Prior to our first counseling session, I will need you to complete each of these 7 forms.

After filling out the first form, you will be provided with the next form, until the last has been completed. This may take 15-30 minutes or more.

Form 1 of 7

Client Information & Insurance

  • Client Info
  • Contact Info
  • Goals
  • Home Info
  • Emergency Contact
  • Medical Info
  • Therapy History
  • Work & Education
  • Signature
  • Primary Insurance Company

Client Information

First
Last
Gender *
Address *
Address
City
State/Province
Zip/Postal
Client Relationship to Insured *
Sending

Breath In This Moment and
Exhale With Gratitude