Forms

After scheduling your first appointment, please complete the New Client Information & Agreements Packet to be prepared for your initial appointment. You will fill out these forms online. Completing these steps beforehand will allow more time for you to speak with your therapist about the issues that bring you to counseling. If you will be attending couples therapy, both partners should read and sign the same forms.

The New Client Information & Agreements Packet includes both basic information about yourself and all the information you need to begin the counseling process (e.g., policies regarding fees, payment, communication, confidentiality, HIPAA, and other pertinent information).





List of Additional CCC Forms:

Most clients only need to complete the New Client Information & Agreements Packet above.

  • ACH Bank Transfer Authorization Form: If you would prefer the convenience of paying by bank transfer (rather than paying with a card, check, or cash in each session), please complete this secure form online.
  • HIPAA Policy: All clients should read CCC’s policy of compliance with Federal Requirements Regarding Confidentiality.
  • Authorization to Release Information Form: If you need your therapist to share any information with an outside party, please complete this form online. For couples therapy clients, both parties will need to sign.
  • CCC Credit Card Authorization Form: If you are a parent/legal guardian of a minor who will be attending therapy, and if you will not be present to pay for each session, please complete this secure form online.