Coastal Haven Counseling Forms

Download Forms Here

Adult Intake Forms

Group Professional Disclosure Statement Form

Adult Initial Clinical Assessment Form

Copay Credit Card Authorization Form (Not needed for Medicaid Clients)

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

Child Client Intake Forms

Group Professional Disclosure Statement Form

Child Initial Clinical Assessment Form

Copay Credit Card Authorization Form (Not needed for Medicaid Clients)

CONTACT US FOR MORE INFO OR TO SCHEDULE AN APPOINTMENT