Adult Client Intake Forms

Depending on the type of counseling service you are seeking, please print out and complete the appropriate forms below and bring them with you to your first session completed:

Individual Adult Counseling and Coaching Intake Forms:

• Agreement Between Client and Therapist
• Adult Checklist of Concerns
• Adult Counseling and Coaching Intake Form

Couples / Marriage Therapy Intake Forms:

• Agreement Between Client and Therapist
• Pre-Counseling Couples / Marriage Questionnaire
• Couples Counseling Intake Form

Biofeedback, relaxation training, or pain / illness / disability management:

• Agreement Between Client and Therapist
• Adult Checklist of Concerns
• Daily Life and Abbreviated MPI Questionnaire
• Adult Pain Management and Biofeedback Intake Form

If you have a medical / other mental health provider or other appropriate entity you wish for us to communicate with and coordinate your care, please also complete the following form and bring it with you to your first session.

• Authorization for Release of Information and Reciprocal Exchange of Information

Note: You will need Adobe Acrobat Reader to open the intake forms which are in PDF format. To download Adobe Acrobat Reader for free, click here.