Below, please give a summary of what brings you to counseling today, and what you'd like to accomplish. This is confidential between you and your counselor or coach.
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Questions or concerns? Please let us know and we'll get back to you as soon as possible
By checking the box below I (client) agree and understand that:
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My counselor will keep my information in complete confidence
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All appointments and copays will be paid in advance
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Therapy and TeleTherapy sessions are for personal therapy only and these sessions/records will not be used for obtaining Disability Benefits, Social Security benefits, or for court cases
