Forms

New patients will be asked to complete the following intake forms prior to their initial appointment. We have made these forms available here for download if you prefer to fill them out before your arrival. If not, please arrive 20-25 minutes prior to your appointment start time to complete these forms. If you are coming for couples counseling, each partner should complete his or her own Adult Intake form.


Informed Consent and Policies

Patient Intake Form


At times, it may be helpful or necessary for your therapist to coordinate care with your primary doctor, with your child's school or with other helping professionals involved. If you anticipate this to be the case, please download and complete the following Release of Information. Your therapist can assist you if you are unsure how to complete any part of the form.

Release of Information

Additional forms that your therapist might recommend include:

Consent for Couple's Therapy

Credit Card Authorization Form


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

 

 

Lighthouse Counseling Services is a joint venture comprised of Jeff Ferguson SC, Erika Wagner-Martin LLC, Jane Sweney LLC, Cathy Gierszewski LLC , JMCrabb LLC and Mulcahy Counseling LLC. All therapists are individually self-employed and will inform clients separately if their respective informed consent and policies differ than what is provided on this website.