Please print and fill out appropriate forms
*Intake
*Consent to Treat
*Privacy Practices
Consent to Treat --Phillip Boone, AMFT (pdf)
DownloadConsent to Treat--Nicholett Bascou, APCC (pdf)
DownloadConsent to Treat--Rose Garcia, ACSW (pdf)
DownloadAdult Intake (pdf)
DownloadMinor Intake (pdf)
DownloadPrivacy Practices (pdf)
DownloadInformed Consent Form - NBascou (pdf)
DownloadInformed Consent Form - Brittany Kohlberger; PhD (pdf)
DownloadInformed Consent Form - Carmelita Horne; LMFT, LPCC (pdf)
DownloadWe are currently utilizing a HIPAA compliant video conferencing platform to support your efforts of maximizing the safety of yourself and the ones you love.
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National Sexual Assault Hotline 1 800 656 HOPE
Safequest (DV & sexual assault) 1 866 487 7233
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Emergency 911
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