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)

TeleHealth / TeleTherapy Informed 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

Child Client Intake Forms

Group Professional Disclosure Statement Form

Child Initial Clinical Assessment Form

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

TeleHealth / TeleTherapy Informed Consent Form

CONTACT US FOR MORE INFO OR TO SCHEDULE AN APPOINTMENT