Forms

Please take the time to fill out the following forms, this will help us make better use of your time during your first session. Each person involved in counseling should fill out the forms individually.

Client Intake Form

Dan Pippinger Informed Consent

Rebekah Deitrich Informed Consent

Judy Hessler Informed Consent

Kate Pippinger Informed Consent

Self Assessment

HIPAA Compliance Form

Insurance Form (You only need to fill this out if you think your insurance will cover counseling)
– If we are out of your insurance network, we are glad to bill to your insurance as out of network providers.

Credit Card Authorization (If you intend to have your therapist charge your credit card as payment)