New Patient Forms

If you are visiting Capital Counseling for the first time, there is information we’ll need to gather from you, and disclosures you’ll be asked to read and acknowledge.  You can save time at our offices by reviewing and completing these forms in advance of your initial visit.

Read and Review

These important forms explain your rights and terms you should be aware of. Please read them carefully. These are for you to keep – you do not need to bring them with you.

downloadpdfHIPAA Statement and Notice of Privacy Practices

downloadpdfStatement of Understanding and Terms of Service

Required for your visit

You will be required to complete the following forms before your first session. Completing these in advance of your visit and bringing them with you will save you time at our offices.

downloadpdf2014 – Client Information Form

downloadpdf2014-Pre-Treatment-Wellness-Self-Assessment-Adult

downloadpdfPre-Treatment-Wellness-Assessment-Youth