Forms
Consent & Authorizations
General consents for all new clients to complete at intake
Telehealth Informed Consent
Download here.
Referral Form
To be completed by referral source (i.e. client, parent/guardian, physician, etc.)
Student Consent
Consent form to provide treatment to students at schools
Release of Information Consent
Consent to release information from client records to a designated source
Registration Form
(For Continuing Education – Suicide Assessment, Treatment, & Management – 10-28-16.) Course approved by LPC board for 6 continuing education hours to meet regulatory requirements established in 201 KAR 36:030 for LPCCs and LPCAs
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We're here to help. Call us now at (606) 451-1936 or fill out this secure form to request an appointment. One of our team members will be in touch ASAP.