Child Intake Form

Please complete if you are seeking counseling for your child, ages 3 to 11.

Adolescent Intake Form

Please complete if you are seeking counseling for your teen, ages 12 to 17.

We are so glad that you have chosen to seek counseling with Sacred Space Counseling Center in Irving, TX.  In order to make the most effective use of our time during your first visit, you are welcome to print and complete the applicable forms below:

Adult Intake Form

Please complete if you are over 18 years of age and seeking counseling.

*** If you do not have access to a printer, we will be happy to have the forms available to be completed in our lobby prior to your scheduled intake appointment.  Please allow 30 minutes to complete the required forms.

Counseling at Sacred Space is confidential, but we realize that there are times you may want your counselor and/or your child's counselor to speak with another individual such as teacher, school counselor, minister, psychiatrist, etc.  If you would like to authorize this, please complete the appropriate form below.

Adolescent Intake Packet
Child Intake Packet
HIPAA Form - Minor
Adult Intake Packet
HIPAA Form - Adult
Release Form - Adult
Release Form - Minors
HIPAA Form - Minor

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