FORMS and HANDOUTS

Below you will find forms and handouts that will be helpful in yours or your child's therapy process.  You can download and print out at your convenience.

New Client Forms

New Client Packet

New Client Packet - Shared Custody

Other Forms

Authorization to Release Information

This form allows you to identify what Personal Health Information you would like us to release to another provider or individual.  It is important that you read it carefully and talk with your clinician about what you would like shared.  You may also designate how long the release is in effect for.  Please know that you may revoke this privelege at any time.

Rules for Divorcing Parents

This handout provides guidelines for parents who are going through a separation, divorce or long-term custody disputes.  Children who live with the stressors of parents' emotions are more likely to have difficulty concentrating in school, experience a drop in grades and often have an increase in emotional outbursts. 

Links and Resources

Violent Crimes Compensation Board Application

If your child has been the victim of a violent crime and the case is under investigation, he or she may be eligible for monies for counseling.  You may go to our resources page and follow the link to the VCCB website for more information.

Teaching Children to Calm Themselves

Read for some helpful information how to work with your child to learn to calm themselves.

EMDR Therapy with Children: Journey Into Wholeness by Ana Gomez, MC, LPC and Francine Shapiro, PhD