Forms

Home / Forms

Client Forms

If you’re a new patient, print out the appropriate form for Adult or Child, bring the completed form to our office at the time of your appointment. The signature forms need to be signed, also. You may print them out and sign them or sign them at the time of your appointment. These signatures are required before you may be seen. It is the patient’s responsibility to read the Office Policies. Appointment Times are from 45 to 55 minutes.

Adult Intake Forms

Child & Adolescent Intake Forms

Signature Forms

Office Policies

Other Resources

Ohio Hotlines:

  • Choices: Crisis Hotline – 614-224-4663
  • Choices: Domestic Violence – 614-258-6080
  • DBSA (Depression & Bi-Polar Support Alliance of Ohio) – 419-255-1459
  • First Link – resource guide – 614-221-2255
  • Franklin County Children Services – 614-229-7000
  • Netcare Access (Mental Health Emergencies)  – 614-276-2273
  • ODADAS (Ohio Department of Alcohol and Drug Addiction Services)  – 1-800-788-7254
  • Ohio State University Emergency Room – 614-257-3000
  • Suicide Prevention – 614-221-5445
  • Suicide Prevention Teen Line – 614-294-3300

National Hotlines:

  • Al-Anon, Family Groups – 212-301-7240
  • Alcoholics Anonymous – 212-686-1100
  • Battered Women’s Task Force – 414-466-1660
  • Bulimia/Anorexia 24 hour Crisis Line – 800-762-3334
  • Child Abuse Hotline – 800-442-4453
  • Council on Alcoholism & Drug Dependence – 212-206-6770
  • Eating Disorder Hotline – 800-233-5450
  • National Legal Aid & Defender Association – 202-452-0620
  • Narcotics Anonymous – 818-780-3951
  • Runaway Hotline – 800-231-6946
  • The Grief Recovery Institute – 800-445-4808