Forms
Required Forms to DownloadINTAKE 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
Form.Intake PDF
Form.Intake RTF
Form.Intake Word
AUTHORIZATION
Form.Authorization for face to face counselling treatment1 PDF
Form.Authorization for face to face counselling treatment1 RTF
Form.Authorization for face to face counselling treatment1 Word
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.
Form.Home Visit Safety Checklist PDF
Form.Home Visit Safety Checklist RTF
Form.Home Visit Safety Checklist Word
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
Form.Consent for exchange of information1 PDF
Form.Consent for exchange of information1 RTF
Form.Consent for exchange of information1 Word
VIDEO AND PHONE COUNSELLING AUTHORIZATION FOR COUNSELLING
Form.Authorization for video and phone counselling1 PDF