Forms

If you are a new client, welcome to Clinical Counseling Services!  As you know, starting with any new health care provider requires some paperwork.  So, before your first appointment, we ask that you review and complete a few forms.  They include the Client Intake, Consent to Treat and the Client Rights and Responsibilities forms.  If you are bringing in a client under the age of 18, the same forms (identified for minors) need to be completed and signed by the parent or legal guardian.

If you want your therapist to coordinate care with another provider or to be able to share information with someone, (for example, a psychiatrist, primary care physician, etc) please complete the Release of Information as well.

Welcome Letter
Consent to Treat - Adult
Client Intake - Adult
Client Rights & Responsibilities - Adult
Release of Information
Consent to Treat - Minor
Client Intake - Minor
Client Rights & Responsibilities - Minor

 

 

Note: Adobe Acrobat Reader is required to download these forms. To download Adobe Acrobat Reader for free, click here .

Helpful Forms

Click here to view and print forms for your appointment.

Click Here

Clinical Counseling Services

(513) 469-6226
4055 Executive Park Dr.
Suite 210
Cincinnati, OH 45241