Client Forms

If you are new to our practice, we look forward to meeting you. Please print out and complete the forms below and bring to your first session. ​

CCH – Consent for Services

CCH – Intake Form


We do not work directly with any insurance companies nor are we on any insurance panels. If you require a statement of service or “superbill” for insurance reimbursement, please fill out the following form and your therapist will sign it. It is the Client’s responsibility to track the dates of services rendered. Some Clients prefer to have the form signed every session while others choose to chunk dates together. We suggest you find what works best for you and filing for reimbursement. Prior to signing the form, your therapist will ensure that the dates of services are correct but it is not their responsibility to identify if there are missing dates.

Statement of Services Form


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