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FORMS | Connie Holland, LPC, NCC, BC-TMH

CHILD INTAKE
PAPERWORK

ages 5-17

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ADULT INTAKE 
PAPERWORK

ages 18 & up

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CONFIDENTIALITY &
DISCLOSURE STATEMENT

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FORMS | Jacey Wall, P-LPC, NCC

COUPLE'S INTAKE PAPERWORK

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ADULT INTAKE 
PAPERWORK

for ages 18 & up

CONFIDENTIALITY &
DISCLOSURE STATEMENT

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TELEHEALTH CONSENT FORM

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