Forms and Information

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, 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 MS Word and .pdf files in Adobe Reader. If a .pdf opens in MS Word, 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 some of the intake forms as instructed, or complete them manually.  Completed and signed forms may be securely emailed to your counselor or securely faxed to 540-662-2874.

There are several ways to pay for counseling services. Please take a few minutes to read about your options at Paying for Counseling. 

Thank you for your assistance.