This form allows consent to treat and gives details regarding confidentiality. Please review and bring with you to the first session. We will go over it during the first sesion.
This form asks you for your basic information (name, contact info, etc.) as well as additional information. Please fill out, sign and bring with you to the first session.
Release of Information (optional)
This form allows me to contact other parties (e.g. doctor, lawyer, clergy, etc.) regarding your treatment. This form is only optional. As a result, you do not need to bring it with you to the first session.
The Marriage and Family Clinic
1333 W. 120th Ave.
ste #218. Westminster, CO 80234. 720-648-8285
In order to save time in the first session and get right to work, I have included the intake forms here. You will find them on the right sidear. Please print, fill out and bring with you to the first session. If you are uncertain about anything in the forms, leave that section blank. We will review these forms during the first session in order to answer any questions you may have.
These documents are in PDF format and may require you to download and install Adobe® Reader.
