Please print, complete and bring these two forms  with you to your first appointment.

 

Please review the forms below.  They do not need to be printed however they include important information about Child Parent Counseling and your therapist.

Thank you for making an initial appointment with Child Parent Counseling.  We look forward to meeting you.  During your first session, your therapist will explain the therapeutic process, review policies and confidentiality, discuss the risks and benefits of therapy and answer any questions you may have.  If your child will be attending the initial session, your therapist will spend time meeting with each of you separately.  Your therapist will gather background information and make initial recommendations for treatment.  After the first couple of sessions, a treatment plan will be  created with you and your child together.  Goals will be established to measure progress.  We will collaborate with other important people in your child's life, relevant to treatment, such as your child's pediatrician, school, psychiatrist or other types of providers.     

 

Please bring the following with you to your appointment:

  • Photo ID
  • Insurance card
  • Any records from previous providers
  • Any educational information or testing completed
  • Cash or check payment for the initial session fee of $150 or your co-payment
  • Completed Child Consent Form and Child Information Form (red buttons below)
  • If you are separated or divorced, please also bring a copy of the judge ordered custody agreement.  Both parents will be asked to sign a Waive Subpoena Form at the initial appointment.