1 Counseling Associates P.C.


Forms, Fees and Information

fax Counseling Associates at 540-662-2874

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. Open .doc files in MSWord, and .pdf files in Adobe Reader. If a .pdf opens in MSWord, click on "open in a different viewer" and select "Adobe".

If you schedule an appointment you may download the forms to your own computer to fill out and print in advance of our first meeting. You may type directly into intake forms. Alternatively, you may request that forms be emailed to you.

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 October, 2016. Fees are subject to change.

Thank you for your assistance.

Intake Form:

Counseling Associates Intake Forms Packet. (except for Geoff, see below)
If you have Adobe when your PDF opens there will be a menu to the right of the document. Click on "fill and sign" to type into the documents, then name and save your file to print. If you do not have Adobe you may print first and then fill in the forms manually before returning.

Intake form for a child.

Download Adobe Reader here. Uncheck the two McAfee boxes and the chrome extension boxes, then download The Reader, not the Pro DC. Ignore step 3 and ads

Informational Forms:

Paying for Counseling

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

Intake and financial forms for Geoff only:

Primary Client Form, in whose name you want the account

Client Partner Form for couples

Insurance Information Form - must be completed in addition to card.

All clients need to read and sign this Privacy Rights Form

Free online genogram; right click to open in new tab: Complete and print without saving information which you may bring to your session. If you like you may register and save your family tree on their site, otherwise you will lose the information you have entered.

Additional information that may be important and useful for all clients.

Mental Health Insurance or not.doc

Original 2003 HIPAA Policies for Counseling Associates.doc

Latest HIPAA Policies for Counseling Associates.doc


Click here for an extensive archive of mental health articles, courses and exercises!

A variety of free online self assessment questionnaires.

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