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 either; print out and bring along with you, or save once completed and email your therapist 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 Download to your desktop, and Complete the forms
before emailing the completed form to your therapist, using the provided email, before your first consultation.

Adobe Acrobat Reader is necessary to complete the editable PDF forms on your computer to save and then email to your therapist •
If you do not wish to complete them on your computer, please print out the forms and complete them before 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