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, 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)

Insurance Information Form

Informational Forms:

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

Confidential Release of Information Form

Paying for Counseling

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

Instructions for obtaining Imago Couples Workstation (APP)

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.
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


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

A variety of free online self assessment questionnaires.

Dr. Rick Hansen's weekly emails and Wise Brain Bulletin.
The newsletter suggests a simple practice each week that may bring you more joy, more fulfilling relationships, and more peace of mind and heart. The Wise Brain Bulletin is sent to you six times a year, both for free..

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