616.990.8544
Untangled Counseling
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Forms


Individual Counseling Session Forms

Prior to your first appointment, our 'intake packet' must be completed. Please download the packet from the link below, print documents, fill out, and bring to your scheduled appointment. If you have any questions please contact us.
PATIENT AGREEMENT & HIPPA DISCLOSURE:
Please read prior to completing the 'Intake Form'.
untangled_patient_services_agreement__hipaa_disclosure.pdf
File Size: 152 kb
File Type: pdf
Download File

INTAKE FORM:
Must be completed prior to first appointment. Please print this form, fill out, and bring to your first appointment.
untangled_intake_packet_without_agreement__hipaa.pdf
File Size: 326 kb
File Type: pdf
Download File


Group Counseling Forms

GROUP COUNSELING CONTRACT:
Please print and fill out prior to your first group session.
untangled_group_contract.pdf
File Size: 86 kb
File Type: pdf
Download File

GROUP COUNSELING SURVEY:
Please print and fill out prior to your LAST group session.
untangled_group_counseling_evaluation.pdf
File Size: 84 kb
File Type: pdf
Download File

Release Forms:

RELEASE INFORMATION:
To be printed and filled out when specifically requested by your counselor.
untangled_release_personal_information_form.pdf
File Size: 72 kb
File Type: pdf
Download File

WAIVER AND RELEASE FOR PUBLICATION:
To be printed and filled out when specifically requested by your counselor.
untangled_waiver_and_release_-_use_for_publicaion_of_statement_or_story.pdf
File Size: 43 kb
File Type: pdf
Download File

Untangled Counseling
440 South State Street, Suite 320
Zeeland, MI 49464

616.990.8544

   


www.UntangledCounseling.com
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