Forms

INTAKE FORM

All clients complete this form prior to/start of service and bring to the first session. If you seek service by tele-counselling (video or phone), follow directions at the bottom to submit the form

AUTHORIZATION

 

HOME VISIT SAFETY CHECKLIST

The prospective client seeking in-home service fills out the form prior to the onset of service. The information is used to make a determination to proceed with in-home counselling. Mileage and travel fees apply.

CONSENT TO THE DISCLOSURE, TRANSMITTAL OF INFORMATION 

This form is used if a client wishes information to be shared between Heidi Spiar and another person, professional or agency

VIDEO AND PHONE COUNSELLING AUTHORIZATION FOR COUNSELLING