BRAINsmART Therapy
for trauma and mental health

Intake Forms • Complete before first consultation

Tell us about yourself.

BRAINsmART Therapy Intake Forms


Before arriving for your first consultation with one of our professionals, please complete, and if possible; print out and bring along with you the following three forms. 

If you have not requested an initial appointment or are interested in learning more about a particular counselor's services, please refer to the Make an Appointment page to contact one of our counselors.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. The forms are for general questions or messages to the counselors.


Please Print, Complete, and Bring these forms to your first consultation.

Psychotherapy Intake Form

Our initial evaluation form, to be brought to your first consultation.


Consent for Treatment and Limits of Liability and Cancellation Policy Form


Authorization for Use or Disclosure of Protected Health Information