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PeaceCOMES FROM WITHIN

Intake Forms:

If you are a new client, please print, complete, and bring the following forms to your first session.

 
Consent Forms (All Clients): 
  1. Summary of Office Policies
  2. Informed Consent for Treatment
  3. Informed Consent for Testing
  4. Client Rights
  5. HIPAA
  6. Release of Information
Intake Forms (Adult Clients Only):
  1. Intake (Adult)
  2. Problem Checklist (Adult) 
  3. OQ-45.2
Intake Forms (Child/Adolescent Clients Only):
  1. Intake (Child/Adolescent)
  2. Problem Checklist (Child/Adolescent)
  3. Behavior Assessment for Children (Ages 02 - 05)
  4. Behavior Assessment for Children (Ages 06 - 11)
  5. Behavior Assessment for Children (Ages 12 - 21)
  6. Autism Spectrum Rating Scales (Ages 02 - 05)
  7. Autism Spectrum Rating Scales (Ages 06 - 18)

 

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Helpful Forms

Click here to view and print forms for your appointment.

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