Client Forms

If you are new, please feel free to fill out these intake forms before our first session.
These forms can also be filled out during the first session.

Intake Form

Consent to Treatment Form

Insurance Release Form

Professional Disclosure Statement LPC

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information (ROI)

5103 Eastman Ave. Ste 229 , MI
Midland, MI 48640
(989) 423-8945

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