Our Forms

 

PLANNING YOUR FIRST VISIT?

If you are a new client, please print and complete the ALL forms from the applicable sections below and bring them to your first session. We look forward to seeing you then.

For Individual Therapy (Adults)
Legacy New Client Intake Form
ACE Questionnaire
Legacy Changers Adult Self-Report Form
Legacy Changers Adult Informed Consent for Therapy
Legacy Changers Release of Information
Legacy Changers Financial Responsibilities Form
Legacy Changers Notice of Privacy Practices

For Individual Therapy (Children & Adolescents)
Legacy New Client Intake Form
ACE Questionnaire
Legacy Changers Child-Adolescent Informed Consent for Therapy
Legacy Changers Release of Information
Legacy Changers Financial Responsibilities Form
Legacy Changers Notice of Privacy Practices

For Couples Beginning Marital Therapy
Legacy New Client Intake Form
ACE Questionnaire (each spouse complete separately)
Legacy Changers Adult Self-Report Form (each spouse complete separately)
Legacy Changers Release of Information (each spouse complete separately)
Legacy Changers Financial Responsibilities Form
Legacy Changers Notice of Privacy Practices

For Group Therapy
Legacy New Client Intake Form
ACE Questionnaire
Legacy Changers Release of Information
Legacy Changers Financial Responsibilities Form
Legacy Changers Notice of Privacy Practices
    For Adult Group Members
    Legacy Changers Release of Information
    Legacy Changers Financial Responsibilities Form
    For Child – Adolescent Group Members
    Legacy Changers Child-Adolescent Informed Consent for Therapy