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. However, due to the current COVIB 19 health crisis our office are not open to clients. We are currently working in therapy via tele-health services.
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 providing quality mental health services for you and your family.
FORMS:
Street address for mailing forms: 3855 S. Boulevard, Ste 1; Edmond, Ok 73013 or
Secure (encrypted) email address at: counselinginedmond@protonmail.com
web form-1. Notice of Privacy Practices
web form-3. Symptom Check List
Authorization and Consent for Telepyschology and Mental Health Services
Email or SMS Appointment Reminders
Counselors’ Specific Forms:
Paul G. Tobin, Ph.D., Psychologist
Therapist-Patient Agreement 2020 Paul Marital
Therapist-Patient Agreement 2020 Paul
Ann E. Benjamin, M.Ed, Licensed Professional Counselor
Therapist-Patient Agreement 2020 Ann
Therapist-Patient Agreement 2020 Ann Marital
Ann E. Benjamin, M.Ed. Statement of Professional Disclosure
Gracie Moyers, M.Ed., Licensed Professional Counselor
Therapist-Patient Agreement 2020 Gracie
Therapist-Patient Agreement 2020 Gracie Marital
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
Therapist-Patient Agreement 2020 Phyllis
Therapist-Patient Agreement 2020 Phyllis Marital
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
Therapist-Patient Agreement 2020 Nancy Marital
Therapist-Patient Agreement 2020 Nancy
Nancy McReynolds, Ph.D., Statment of Professional Disclosure
Nancy McReynolds, Ph.D. Consent for Services
Moreen Foster, M.A., Licensed Professional Counselor
Therapist-Patient Agreement 2020 Moreen
Therapist-Patient Agreement 2020 Moreen Marital
Moreen Foster, M.A. Statement of Professional Disclosure
Moreen Foster, M.A. Consent for Services
Fred McGinn, M.A., Licensed Professional Counselor,
Licensed Drug and Alcohol Counselor
Therapist-Patient Agreement 2 2020 Fred Marital
Therapist-Patient Agreement 2 2020 Fred
Consent for Services for Minor Fred
Kimberly Spears, M.Ed., Licensed Professional Counselor
Consent for Services for Minor Kim Spears
Therapist-Patient Agreement 2020 Kim Spears
Janet Stafford, M.Ed., Licensed Professional Counselor
Therapist-Patient Agreement 2020 Janet
Therapist-Patient Agreement 2020 Janet Marital
Janice Kimball, M.S.W., Licensed Clinical Social Worker
Therapist-Patient Agreement JK 2020
Therapist-Patient Agreement JK 2020 Marital
Andrea Larabee, PhD, Health Services Psychologist
Therapist-Patient Agreement 2020 Andrea
