Therapy Counseling Forms

If you’re a first-time client, the most important form is the New Client Form (customized for each therapist). The New Client Form contains the Therapy Outpatient Contract and space for you to let your therapist know important information. To make it more convenient for you, Chappell Therapy Counseling forms are available for download below. Please take a moment to fill them out (the form that corresponds with the therapist you are seeing) and bring them in to the first session. This will save us some time when you get to the office.

New Client Form – Jennifer-Chappell-Marsh-New-Client-Intake | AlexandraMcCoy_Client Intake Form

This form gathers the basic information needed to start Therapy. You will list your name, address, contact information and state the reason for seeking counseling services. The Intake form explains in depth Therapy policies including Confidentiality, Terms of Services and Cost. If you are seeking Couples Counseling, please provide information and signatures for both parties.

Included in the Intake Form is the Appointment Credit Card Form – In order to reserve your Chappell Therapy Counseling appointments, we ask that a credit card is authorized to be put on file. This information is protected within HIPPA regulations and concept completely confidential. Your information will only be used in the rare event that a counseling session is missed without giving the required 24hr cancellation notice. Many clients request automatic payment for sessions and prefer the ease.

Couples Questionnaire – Couples Questionnaire_Chappell Therapy

If you are scheduling an appointment for Couples Therapy, please print our the Couples Questionnaire, fill it out and bring it with you to our first session (one copy for each of you). These questions will help me assess your relationship.

Please feel free to contact me directly with any questions you may have while reviewing these forms. It is important to me that you feel comfortable with any document before agreeing to the terms and conditions.

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