Child & Adolescent Paperwork

This form is for Parents/Guardians to complete.

This form is for your child who is 14 and older. Do not complete if under 14 years old.

This form is for your child to look over (only for children 14 and older). This is a form about privacy and what we share with parents. Your child signs this. Do not give this to children who are younger than 14 years old.

When you’re done with this form, click the “X” in the top right corner of this box.

Request for Therapy Session

Request for Therapy Session

When finished, click the submit button, and then close this box by clicking the “X” in the top right corner.