Below are links to various forms that are used throughout the intervention.  While they seem lengthy, it is often very important that we have complete and varied information.  Remember any time you spend filling out these forms, saves later time and costs seeing a therapist.

They are provided as Adobe Acrobat files, so Acrobat reader will be needed.  You can click here to get the free reader.

Instructions for intake forms:  Please fill out this form to the best of your ability.  Some sections may not be applicable and you may simply indicate on the form.  Remember that some things that do not seem necessary to you, may be very important to us.  If you do not answer all the questions needed, we will have you answer them in session.  You may also want to print out and fill out an "Exchange of Information Form" for any past therapists you may have seen and/or the professional that referred you. 

Each intake packet has for sections:

                  1)  A cover sheet with basic information (signature is needed),

                  2) All the requested information (several pages)

                  3) A medical checklist

                  4) A three page Informed consent.  The business agreement (initials and signature required). - Only found in Parent and Adult Packet.

Adult Intake Packet

This form is used when an adult or couple is coming to counseling. 

If you are being seen as a couple, we need each each of you to fill out a form.

 

Parent Intake Packet

Used when seeing a child, adolescent or teenager.  I also need this filled out before our first meeting.

 

Student Intake Packet

There is a lot of information that is needed.  If the adolescent or teenager can fill out this form before coming in, it will save time.

Child Intake Packet

           This form is still being designed to get a younger child's input on what is happening from their point of view.

Informed Consent

This is the contract between us.  It explains the office hours, fees as well as confidentiality issues. This is required before you begin therapy and is part of the above intake packets.

 

Request/Exchange of Information

As part of confidentiality, we cannot talk to anyone without your consent.  This form allows us to talk to anyone you think we need to.

Baseline Chart

Chore/Behavior List

Sample Communication form - KCA Presentation

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