FORMS

Intake Packet

 

Download and complete/ have your client complete all these pages and follow these directions.

Complete all documents on the computer or on a hard copy and bring a printed, completed copy to the appointment; therapy, psychological evaluation or EMDR if you can. If you prefer doing so online or cannot print the pages, email the completed pages to wendy@calomiriscounseling.com.

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Click on each link to download the document.

• Client intake form for evaluations

• Informed Consent Form

• Informed Consent Form for telemedicine services

• Release of Information (to share with attorney)

• PTSD_CheckList_and_Scoring

• Beck Depression Inventory

• Burns Anxiety Inventory

• Additional Individual Intake Questionnaire

• In case of emergency

• Acknowledgement of Receipt Notice of Privacy Practices

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If the client is a child, please fill the next forms:

• Child Development Milestones

  • Only use for children/adolescents, and print the age that applies to your child/client, fill this out yourself

• Beck Depression Inventory for Children

  • Only use for children/adolescents, have them fill this out