Electronic Client Forms

Follow Our Easy, Step By Step Process:

  Note: We recommend that you download/save the forms so you can easily make changes, and then re-print them.

1. Locate

Click on the desired form; it will open in your browser.

2. Fill In

Fill in the appropriate form fields.

3. Print

Click the print button to print the form.

4. Sign

Sign the printed forms; bring them with you to your first appointment.

Adult Counseling Forms

  1. Cover Letter
  2. Consent for Services & Fee
  3. Authorization for Scheduling, Billing and Payment Purposes
  4. Cancellation Policy
  5. PF1000 Notice of Privacy Practices
  6. PF2000 Privacy Consent
  7. Adult Intake form
  8. Notification and coordination with Primary Care Physician-Psychiatrist
  9. Emergency Contact Authorization
  10. Consent for Self-Pay Fee Sessions

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Minor/Adolescent Forms​

  1. Cover Letter
  2. Counseling Minors
  3. Consent for Services & Fee
  4. Authorization for Scheduling, Billing and Payment Purposes
  5. Cancellation Policy
  6. PF1000 Notice of Privacy Practices
  7. PF2000 Privacy Consent
  8. Minor/Adolescent Intake Form
  9. Notification & Coordination with Primary Care Physician-Psychiatrist
  10. Notification & Coordination with Education Professionals
  11. Emergency Contact Authorization

Adult LENS Neurofeedback forms

  1. Adult Consent form
  2. Intake form
  3. CNS Questionnaire
  4. Sensitivity Questionnaire
  5. Photonic Stimulator Informed Consent
  6. Emergency Contact Authorization

Minor/Adolescent LENS Forms

  1. Minor/Adolescent Consent form
  2. Intake form
  3. CNS Questionnaire
  4. Sensitivity Questionnaire
  5. Photonic Stimulator Informed Consent
  6. Emergency Contact Authorization