Intake forms for First-time Clients

For your convenience, you make print and complete the Patient Forms before visiting the office. If you are unable to complete these forms prior to your visit, please arrive at least 15 minutes before your appointment time to complete the forms.

Insurance

If you are using insurance, please fill out the insurance forms and bring them to your session.

Insurance Form

Employee Assistance Program (EAP)

If you are using your Employee Assistance Program (EAP) please fill out these forms prior to session. Myers Counseling Group works with different EAP’s and each one may require additional paperwork than included here.

EAP Form

Additional Forms

The following forms are included for your convenience. If you are using insurance or are self pay, you can use this form to make payments (if you choose to pay by credit card). Please fill them out and bring to your first session.

Credit Card Form

HIPPA Form (Read Only)

The following forms are additional forms your therapist may ask you to fill out. Unless requested to do so, you do not need to bring these to your initial session.

Release of Information

Symptom List for Children