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
