952-595-5967   |   info@traversecc.org

Traverse Counseling & Consulting

Therapy and Consulting

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Client Forms

If you’re a new client, please complete the following client forms and bring them to your first session.

Location Map

General Client Information(Complete and bring with you to the appointment)

Teletherapy Agreement and Informed Consent (Print and scan to our office prior to your appointment)

Learn more about Telehealth – Click Here

Adult Client Intake Form (Complete and bring with you to the appointment)

Adult Intake – Couples Counseling Form (Complete and bring with you to the appointment)

Child & Adolescent Intake (for clients 12-18 yrs. old – Complete and bring with you to the appointment)

Client Rights & Responsibilities (Review, sign and bring with you to the appointment)

Traverse Counseling & Consulting Policies (Review, sign and bring with you to the appointment)

Notices of Privacy Practices (Review)

If you would like us to coordinate care with another provider (i.e. a psychiatrist, primary care physician, etc.), complete this form to authorize release of information:

Authorization to Disclose Information Form (Complete and bring with you to the appointment)

 

Note: To download Adobe Acrobat Reader for free, click here.

Note: Depending on the service requested, there may be other forms required. Please contact our office for more information.

Traverse
Counseling & Consulting, GBC

Plymouth, Minnesota

Phone: 952-595-5967

info@traversecc.org

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952-595-5967
info@traversecc.org
9800 Shelard Pkwy, Suite 215
Plymouth, MN 55441

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