Client Intake Form
You have just taken a very positive step by deciding to seek counseling. We are happy that you have chosen Collaborative Counseling Group. Please take a moment to fill out some information about yourself.
The Intake form & Disclosure Forms may be downloaded here. Please print form, fill it out and bring to your first appointment.
| ccg_intake_form.pdf |
| disclosure_and_client_informed_consent_wimmer._b_.docx.pdf |
**For a couple’s intake session, please fill out two individual intake forms.
** Parents and Guardians, please fill out the Additional Counseling Information form for your child or adolescent who is seeking counseling.
** Parents and Guardians, please fill out the Additional Counseling Information form for your child or adolescent who is seeking counseling.
Payment Information
We are not currently paneled with any insurance company. We will assist you with out-of-network reimbursements by providing the required paperwork for you to submit to your insurance company. Payment is expected at the time of service. Checks, cash, credit cards (except American Express) and the option of using your HSA card.
There is also a 24-hour cancellation policy or full payment will be applied. *Please read disclosure statement*
There is also a 24-hour cancellation policy or full payment will be applied. *Please read disclosure statement*
