These files are in a fillable PDF format, and contain the intake forms and questionnaires that you will be asked to complete prior to your first appointment.
You may download the form, open through Adobe Acrobat Reader, complete, sign electronically, and email to firstname.lastname@example.org. Alternatively, you may print out the form to complete, sign, scan, and email to email@example.com or faxed to the office at 919-401-8091.
All forms need to be completed and returned to the office before a appointment can be scheduled.
2. Intake Form & Policies
3. Adult History Form This form is for adult clients.
4. Child/Adolescent History Form This form is for clients ages preschool through high school.
5. HIPPA Forms
6. Consent to Release Information
7. Credit Card Authorization Complete this form to put a credit card on file to facilitate payment for therapy.
9. Teletherapy Form