Rose Hanna Counseling Services

Client Forms

Forms for new and existing clients. You are welcome to complete these before your first session or fill them out when you arrive.

New Client Intake

Client Intake Form

Complete before or during your first session. Covers personal history, presenting concerns, and consent to treatment.

Provided at your first appointment. Contact us if you would like to receive it in advance.

Information Sheet

Practice policies, fees, and your rights as a client.

Provided at your first appointment.

Coordination of Care

Authorization for Release of Information

Use this form if you would like your therapist to collaborate with another provider — a physician, psychiatrist, school counselor, or other professional.

Download PDF

Have questions about a form, or need something sent ahead of your appointment?

Ready to begin?

Take the first step toward healing and growth. Request an appointment today.