Forms for Psychotherapy,
Behavioral Services,
and Groups
After you have called to book an appointment for counseling or behavioral services, please print out the following forms as applicable and bring to your appointment.
If you are registering for a group, please call our office to register, complete the appropriate forms, and fax to our office: (239) 321-5187. **For minors, we require both parents/legal guardians' written consent.
“Beginnings are scary. Endings are usually sad, but it’s what’s in the middle that counts. So, when you find yourself at the beginning just give hope a chance to float up and it will.”
Birdie-Hope Floats
Forms for Counseling and Behavioral Services
Required: #1, 2, and 4, plus:
#5 for Adult or #6 for Parent of Child or Adolescent (one set of each forms required per child if more than one child will be receiving treatment).
#6 only if we will need to consult with other professionals involved (eg. psychiatrist or other therapist)
