Carolina Counseling Inc. - Personal, couples, and family counseling
Forms you may need
 
All new clients should read the Client Services Agreement and the Notice of Privacy Practices. New clients are asked to print out (or follow the link for the electronic version where available) the appropriate documents in the "Intake Forms" section below, complete them, and bring them to the first session or email/fax them to us. In order to conserve paper, only the signature pages of the Client Services Agreement and the Notice of Privacy Practices need to be printed. The signature pages are coded with a revision date that allows us to track which version of the document you signed.

Client Service Agreement - Full Document - click HERE  

 
 
CCI Notice of Privacy - Full Document - click HERE 



You may also choose to complete and bring with you one of the screenings below:

Anxiety           Depression


 
Intake Forms
Select documents below based on client type.


Click HERE for a printable version of the Adult Intake form with just the signature pages of the Service Agreement (SA) and Notice of Privacy (NP) forms - To view the full documents, please click HERE (SA) and HERE (NP)  or scroll up.


 
     

Click HERE for a printable version of the Child/Youth Intake form with just the signature pages of the Service Agreement (SA) and Notice of Privacy (NP) forms - To view the full documents, please click HERE (SA) and HERE (NP)  or scroll up.

 

Couple 
Please note: Partner One is the primary insurance holder and the name for which the appointment will be scheduled. Partner Two is the other person(s) who will be joining Partner One. Each person should complete their own form individually. 



Click HERE for a printable version of the Couples Intake form with just the signature pages of the Service Agreement (SA) and Notice of Privacy (NP) forms - To view the full documents, please click HERE (SA) and HERE (NP)  or scroll up.






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