Peterson Counseling
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Forms

Please download, fill out and bring the following for your first appointment with Andrea:

Adult (anyone over the age of 18): Client information, Adult intake form,  HIPAA form
Minor (anyone 17 and under): Client information, Child Intake,  HIPAA form
Couples or family: Client information (only one) and adult or child intake form for each participant

Due to confidentiality restrictions, if you'd like me to speak with another professional (court, CPS, psychiatrist, attorney, school, etc), person of your choosing regarding billing and/or treatment information I need a signed consent to release information form.

clientinfopp_insur_v5.docx__1_.pdf
File Size: 88 kb
File Type: pdf
Download File

adultintakeppv5.docx.pdf
File Size: 157 kb
File Type: pdf
Download File

childintakeppv5.docx.pdf
File Size: 206 kb
File Type: pdf
Download File

hipaa_pp_rev1.pdf
File Size: 76 kb
File Type: pdf
Download File

roippv1.docx.pdf
File Size: 59 kb
File Type: pdf
Download File

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