Patient Forms

Thank you for choosing Advanced Counseling Services. For your own convenience, please take a moment to fill out these required documents. The following forms are required in order to begin counseling services, if you have already registered with the intake department you may access the patient portal to complete your forms. You may also complete your forms and submit them online, or print them out and bring them to your first session.

Necessary forms include:

1. Child & Adolescent Form or Adult Personal History Form.

2. Consent and Authorization for Service

3. Patient Health Questionnaire

4. Telehealth Informed Consent (if applicable)

5. Coordination of Care with Primary Care Physician - Release

Again, thank you for selecting Advanced Counseling Services and for your cooperation in the completion of the aforementioned documents.

3 options to choose from to fill out your forms:

Complete Forms in Patient Portal

Complete your forms within your Patient Portal if you have already registered for an appointment through our intake department. Select this option ONLY if you have already been provided a Login ID and Password.

Patient Portal

Complete & Submit Forms Electronically

Complete your forms online through Jotforms and it will be emailed to our administration and your therapist. Very easy to complete online!!

Adult Personal History Form

Child Personal History Form

Telehealth Informed Consent

Consent & Authorization for Services

Patient Health Questionnaire

PCP Coordination of Care

Release of Information

Print PDF & Bring in Completed Copy

You can click on the links below to download and print your forms at home, and complete by hand. Be sure to bring in your completed forms at your first appointment!

Additional PDFs that you can view but do not need to complete before your visit:

Locations Phone

Patient Forms

3 options to choose from to fill out your forms:

Complete Forms in Patient Portal

Complete & Submit Forms Electronically

Print PDF & Bring in Completed Copy