Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

Child Specialist / Mediation
Client Consent for E-mail, Cell Phone & Text Communication
Child History - Under the Age of 5
Child History - Over the Age of 5
Mediation Registration
Mediation/CS/Parent Consult Agreement
Child Specialist/Parent Consultant/ Family Mediator Participation Agreementdf

Co-Parenting Therapy
Client Consent for E-mail, Cell Phone & Text Communication
Co-Parenting Agreement
Mediation Registration
Authorization for Release of Confidential Information
Telehealth Consent

Therapy Services
Client Consent for E-mail, Cell Phone & Text Communication
Fee Schedule and Policy
Consent for Admission for Mental Health/Consultation or Treatment
Notice of Privacy Practices
Summary of Client Rights
Personal History Form
Telehealth Consent

Parent Consultant/Divorce Coach
Child Specialist/Parent Consultant/ Family Mediator Participation Agreement
Mediation Registration Form

Reunification Therapy
Informed Consent for Reunification Therapy
Telehealth Consent

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