Please complete each of the forms below.

These forms are required for your first session.

Copayments or Coinsurance payments are due at time of visit.

Payments can be made by either a Check or Cash payment.

Thank you.

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(Please print this questionnaire in as much detail as possible.  There are questions that do not apply to you.  You can skip those.  Bring this form to your first session.)

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Please complete this form if you are coming for marriage/couples therapy.

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Please circle the number corresponding to how you feel at this time. These forms are to be completed and brought with you to your first session.

Please circle the number corresponding to how you feel at this time. These forms are to be completed and brought with you to your first session.

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