Contact Us: 
(614) 948-3273
Child, Adolescent, and Adult Counseling

Client Intake

In order to schedule an appointment for counseling services, please complete the below forms - in order, from Intake Form to Release of Information.  Once received, our Intake Coordinator will contact you for further information and to schedule your appointment.    If you have any questions about any of our forms, please contact a member of our staff for more information. 

The Welcome Packet is for your review only.  You do not need to print the Welcome Packet.

The Adult or Child Medical History form and Consent for Treatment forms are required prior to your first appointment.  These forms provides us with the necessary information to prepare to meet you and to accurately complete your assessment.  Please take your time in completing the forms. 

Please submit your Health Insurance Card with your Intake Form.  Please bring your Picture ID to your first appointment.  Also, your copay is made at the time of each appointment.  EAP authorizations must be submitted to our office prior to first appointment.


To reduce the risk of missing a form please begin at (Intake form)  Once completed you will automatically be prompted to complete the next form on the list.