Intake Forms for First Counseling Session:
You may also fill this out when you come to the first session.
First Form – Consent Form
Please, print this form (including a copy for yourself), read, answer yes or no in three places, sign, and bring to the session.
Second Form – Intake Information Form
Please, print this form, fill in, sign, and bring to the session. You may skip the insurance information if you have your insurance card for us to copy. Please print the insured’s name and birth date in this section if that is someone other than you.
Third Form – Kansas Notice Form
If you wish, read and print for yourself. This form is not necessary to bring to your session.
© 2024 by Bernard J. Sullivan, Ph.D. All rights reserved.