Important Forms

If you are a new Client, please complete the following forms and bring them to your first appointment.
NEW CLIENT FORMS

Intake Form
Intake
File Size: 1028 kb
File Type: pdf
Download File

Consent for
​Telemental Health
Consent-Telemental Health
File Size: 44 kb
File Type: pdf
Download File

Information & Agreement
Information & Agreement
File Size: 94 kb
File Type: pdf
Download File
If you would like Vickie to coordinate your counseling with any other professionals (such as a psychiatrist or other medical professional), please complete the Release of Information form.

Release of Information
Release of Info
File Size: 266 kb
File Type: pdf
Download File
THE NO SURPRISES ACT
If you are a new Client, please print and complete the following forms and bring them to your first appointment.

Good Faith Estimate
Good Faith Estimate
File Size: 210 kb
File Type: pdf
Download File
NEW CONSULTATION FORM

Consultation ​
​Agreement
Consult
File Size: 23 kb
File Type: pdf
Download File
NEW SUPERVISEE FORM
If you are a new Supervisee, please complete the following forms and bring them to your first appointment.

​Consent for Telemental Health Supervision

Contract and Agreement
Consent TMH Supervision
File Size: 45 kb
File Type: pdf
Download File
Contract & Agreement
File Size: 23 kb
File Type: pdf
Download File

Please contact Vickie for more information and to schedule an appointment.