Intake Forms

Please complete these before your first session. Each one is a fillable PDF — type your answers right on the form, then save or print it.

• New Patient Information
• Client Rights & Responsibilities
• Privacy Practices Acknowledgement
• Telebehavioral Health Policies, Consent, Procedures
• EMDR Readiness Questionnaire (ERQ)
• Adult Checklist of Concerns
• Billing and Payments

Questions about anything on these forms? Call (386) 473-3290 and we’ll walk through it together.