Coastal Haven Counseling Forms

New Client Forms:

Adult Intake Forms

Group Professional Disclosure Statement Form

Client Demo/Release 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

Client Demo/Release 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