Forms and Fees

In order to facilitate the best use of our time at your first appointment, you may view and download the CA Intake form, Insurance Information Form, the Financial Agreement and other valuable information about fees and methods of paying for counseling. To use the forms, click on the links below. If you schedule an appointment you may download the forms to your own computer to print and fill out in advance of our first meeting. Alternatively, please allow a few minutes before your appointment time to complete these forms at the office.

There are several ways to pay for counseling services. Please take a few minutes to read about your options at Paying for Counseling. We have also provided a list of fees as of April, 2014. Fees are subject to change.

Thank you for your assistance.

Intake Form:

Counseling Associates Intake Form (except for Geoff, see below)

Insurance Information Form

Informational Forms:

NOTE: All clients need to read and sign this Privacy Rights Form

Paying for Counseling

Fees as of October, 2016 (subject to change at any time)

CA Financial Agreement (except for Geoff, see below)

Couples Workstation Information (Online)

Instructions for obtaining Couples Workstation (APP)

Intake and financial forms for Geoff only:

Primary Client Form, in whose name you want the account

Client Partner Form for couples

Premarital Counseling Intake form

Additional information that may be important and useful for all clients.
NOTE: Some files may take a while to download if using a non-broadband connection.

Mental Health Insurance or not.doc

Original 2003 HIPAA Policies for Counseling Associates.doc

Latest HIPAA Policies for Counseling Associates.doc

Link to a copious archive of mental health articles, courses and exercises!

Need Health Insurance? Consumer Reports will help here!

PureRXO nutritional supplements.
Click here for suggested nutritional supplements.

The Healthy Living Shop.
Click here to order supplements; enter your email address and in the provider box type "counselingassociatespc"!