Forms

For your convenience and to expedite the intake process, you will find three forms below which you may print off and complete in advance of your visit. If you are unable to print the forms in advance, please contact me no later than the day before your appointment. I will have these forms available for you in an envelope, with your name, at the front door. In this case, please arrive in ample time BEFORE your scheduled appointment to collect your forms at the door and return to your car to complete them. Come to the door at your appointment time, not before.

 

Please read the documents carefully, Fill out the forms legibly, add your signature where required, and bring all the necessary forms with you to your first appointment. You will also need your driver’s license, your insurance card (unless private pay), and payment (when applicable).

We recommend completing the forms by hand or on a desktop computer.

Confidential Adult Intake Form
Counseling Agreement
HIPPA Informed Consent

Contact Us

Questions or Comments?

Fax

(972) 432-5309

Areas Served

Office is located in the corridor of Shiloh Road and HWY 190, Campbell and Jupiter, easily accessible for Wylie, Murphy, Allen, Plano, Richardson, Garland 75044