Coastal Haven Counseling Forms

New Client Forms:

Adult Intake Forms

Group Professional Disclosure Statement Form

Adult Initial Clinical Assessment Form

Assessment Tool (Cross Cutter) for Adult Client

Copay Credit Card Authorization Form (NOT NEEDED FOR MEDICAID CLIENTS)

ONLY NEEDED FOR TELEHEALTH CLIENTS: Individual Plan of Care Consent Form

Couples Counseling Questionnaire

Also fill out adult forms to the left.

Couples Intake Questionnaire Form

Additional Forms:

Authorization To Release Form

CHC Privacy Practices Info

Client Demographic Info Form

TeleHealth / TeleTherapy Informed Consent Form

Interpreter Services

Child Client Intake Forms

Group Professional Disclosure Statement Form

Child Initial Clinical Assessment Form

Assessment Tool For Child (Cross Cutter) Age 6-17- PARENT FILLS OUT

Assessment Tool For Child (Cross Cutter) Age 11-17 CHILD FILLS OUT

Copay Credit Card Authorization Form (NOT NEEDED FOR MEDICAID CLIENTS)

ONLY NEEDED FOR TELEHEALTH CLIENTS: Individual Plan of Care Consent Form

CONTACT US FOR MORE INFO OR TO SCHEDULE AN APPOINTMENT