top of page

We are so glad that you have chosen to seek counseling with Sacred Space Counseling.  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:

Child Intake Form

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

Child Intake Packet
HIPAA Form - Minor

Adolescent Intake Form

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

Adolescent Intake Packet
HIPAA Form - Minor

Adult Intake Form

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

Adult Intake Packet
HIPAA Form - Adult

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.

Release Form - Adult
Release Form - Minors

*** 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.

bottom of page