A New Day Counseling, Inc.

Behavioral Health Services for Individuals, Couples, & Families

Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize the release of psychotherapy information:

  • Authorization to Disclose Information Form

 

Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Screening Form to Begin Services (ALL New/Potential Clients Must Complete this Form)  

Note: To download Adobe Acrobat Reader for free, click here.

If you are a current client, provider, or stakeholder, please feel free to provide us with feedback to help us with the services we provide. Thank you. This is the information you will need. login 10060523 passwords andc12

Client Survey

Provider Survey

Community Stakeholder Survey

Corporate Compliance Report

Critical Incident Report