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Forms

Client Forms

When completed, these forms will be sent to your therapist for review

Intake Screening Form

–  (Click HERE for the pdf version)

Personal History (Adult Form)

–  (Click HERE for the pdf version)

Personal History (Child and Adolescent Form)

–  (Click HERE for the pdf version)

Agreement regarding Minors pdf

Recipient’s Rights Notification pdf

Preauthorization for Health Care pdf

Payment Contract for Services pdf

Financial Policy pdf

Consent to Treatment and Recipient’s Rights pdf

Request for Alternative Means of Confidential Information pdf

Release of Information Consent pdf

Privacy of Information Policies pdf

 

Client Assessments

When completed, these assessments will be sent to your therapist for review

Adult Self-Report Inventory-4

Alcohol Use Assessment

Anger Situations Form

Are you Dying to be Thin?

Attitudes Toward Cohabitation Questionnaire

Beck Depression Inventory – II

Bulimia Test

Child’s Attitude toward Father

Child’s Attitude toward Mother

Clinical Anxiety Scale

Cognitive Slippage Scale

Compulsive Eating Scale

Compulsiveness Inventory

Concern Over Weight and Dieting Scale

DAST – Adult

DAST – Adolescent

Dysfunctional Attitude Scale

Eating Attitudes Test

Family Adaptability and Cohesion Evaluation Scale

Fear Survey Schedule – II

Fear Test

Generalized Contentment Scale

Goldfarb Fear and Feat Scale

Guilt Scale

Hare Self Esteem Scale

Index of Self Esteem

Intense Ambivalence Scale

Internal verses External Control Of Weight Scale

Internet Addiction Test

Inventory of Religious Belief

Mobility Inventory for Agoraphobia

Novaco Anger Scale

Obsessive Compulsive Scale

Reasons for Living

Restraint Scale

Revised UCLA Loneliness Scale

Self-Efficacy Scale

Self-Rating Anxiety Scale

Self-Rating Depression Scale

Skills for Classroom Success Checklist

Skills for Study Success

Stanford Shyness Survey

State-Trait Anger Scale

Stressors Rating Scale

Teen Alert Questionnaire

Tough Turf Peer Pressure Quiz

 

Client Homework Assignments

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Counseling, Supervision and Training
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