Coastal Haven Counseling Forms
New Client Forms:
Adult Intake Forms
1. Group Professional Disclosure Statement Form
2. Adult Initial Clinical Assessment Form
3. Assessment Tool (Cross Cutter) for Adult Client
4. Copay Credit Card Authorization Form (NOT NEEDED FOR MEDICAID CLIENTS)
5. ONLY NEEDED FOR TELEHEALTH CLIENTS: Individual Plan of Care Consent Form
6. ONLY NEEDED IF YOU WANT RECORDS RELEASED: Authorization to Release Info Form
Couples Counseling Questionnaire
Also fill out adult forms to the left.
Child Client Intake Forms
1. Group Professional Disclosure Statement Form
2. Child Initial Clinical Assessment Form
3. Assessment Tool For Child (Cross Cutter) Age 6-17
4. Copay Credit Card Authorization Form (NOT NEEDED FOR MEDICAID CLIENTS)
5. ONLY NEEDED FOR TELEHEALTH CLIENTS: Individual Plan of Care Consent Form
6. ONLY NEEDED IF YOU WANT RECORDS RELEASED: Authorization to Release Form