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, 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 October, 2016. Fees are subject to change.
Thank you for your assistance.
Intake Form:
Counseling Associates Intake Form (except for Geoff, see below)
Informational Forms:
NOTE: All clients need to read and sign this Privacy Rights Form
Confidential Release of Information Form
Fees as of October, 2016 (subject to change at any time)
CA Financial Agreement (except for Geoff, see below)
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.
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!