Tammie Sprinkle, Office Manager 

We value your time.

This page has down-loadable forms that will become part of your client record within our office.

Often clients prefer to complete and bring these forms to their initial appointment with one of our counselors.

Please call us if you are having trouble down-loading or printing the forms, we will be happy to help you.

We look forward to meeting you.

FORMS:

General Forms:

web form-1. Notice of Privacy Practices

web form-2. Patient Information

web form-3. Symptom Check List

 

Counselors’ Specific Forms:

Paul G. Tobin, Ph.D., Psychologist

Paul G. Tobin. Ph.D. Services Agreement

 

Ann E. Benjamin, M.Ed, Licensed Professional Counselor

Ann E. Benjamin, M.Ed. Services Agreement

Ann E. Benjamin, M.Ed. Statement of Professional Disclosure

 

Lisa L. Marotta, Ph.D., Psychologist

Lisa L. Marotta, Ph.D. Services Agreement

Lisa L. Marotta, Ph.D.  Consent for Services Behalf of Minor Child

 

Gracie Moyers, M.Ed., Licensed Professional Counselor

Gracie Moyers, M.Ed. Services Agreement

Gracie Moyers, M.Ed. Statement of Professional Disclosure

Gracie Moyers, M.Ed. Consent for Services to Child

 

Phyllis Van Hemert, M.Ed., Licensed Professional Counselor

Phyllis VanHemert, M.Ed. Services Agreement

Phyllis VanHemert, M.Ed. Statement of Professional Disclosure

Phyllis VanHemert, M.Ed. Consent For Services to Child

 

Nancy McReynolds, Ph.D., Licensed Professional Counselor,

Licensed Drug and Alcohol Counselor

Nancy McReynolds, Ph.D. Services Agreement

Nancy McReynolds, Ph.D., Statment of Professional Disclosure

Nancy McReynolds, Ph.D. Consent for Services

Moreen Foster, M.A., Licensed Professional Counselor

Moreen Foster, M.A. Services Agreement

Moreen Foster, M.A. Statement of Professional Disclosure

Moreen Foster, M.A. Consent for Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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