Child and Adolescent Intake Forms

Live flowerPlease print and complete all forms for your Child or Adolescent as directed by office staff.  Please do not complete these forms unless your child has been accepted for services.

If you are co-parenting with shared legal custody, we require that both parents complete and submit these forms.  No services can be provided to your child without signed permission/agreement of both parents.

Please submit a copy of both sides of your insurance card with this paperwork.

After the insurance is verified, we will contact you to schedule the Intake Assessment for your child.  For children under 14 years old, parents will be interviewed to discuss the issues.  For co-parents these sessions can be held together or individually.  After the assessment the therapist will discuss with you the best course of treatment for your child moving forward including frequency of therapy sessions.

1. Child-Adolescent Intake

2. 2020 InformedConsent-Individual TherapyAgmt- Child-Adol


4. Telehealth Consent

5. Covid 19 Precautions Agreement

6.Complete this form, only if directed by staff.  Developmental History