For your convenience, please download, print, and fill out the following forms prior to your counseling visit:
New Patient Intake Form (for all counseling except pre-marital counseling)
DOWNLOAD: New Patient Intake Form (481KB/.pdf)
Pre-Marital Intake Form (for specifically designated Pre-marital counseling sessions)
DOWNLOAD for Pre-Marital Intake form: Pre-marital Intake Form (435 kB/.pdf)
Our RCC Disclosure Form
Read our counseling disclosure ahead of time! Information about us as counselors, and as a counseling agency can be found here.
We will talk through our disclosure with you at your initial session. Bring your questions to the first session, and we’ll gladly answer them. DOWNLOAD: RCC Confidentiality and Disclosure Form (373Kb/.pdf)
HIPAA (Health Insurance Portability and Accountability Act) DISCLOSURE
You will sign a document indicating you have received the information or a copy of the HIPAA: Find your copy here. DOWNLOAD: NOTICE OF PRIVACY PRACTICES June 2017 (644KB/.pdf)
Authorization For Counseling Form
DOWNLOAD for Individual/Personal Therapy: Authorization Individual Counseling (182 KB/.pdf)
DOWNLOAD for Couples/Marriage Therapy: Authorization Couples Counseling (180 KB/.pdf)
DOWNLOAD For minor children attending therapy, DOWNLOAD: Consent for Minor Child (191KB/.pdf)
