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21-Day Relationship Challenge

FORMS

  • File

    Client Information Form

     (92K)
    Basic information form for clients. To be filled out before your first session.
  • File

    DASS Weekly Questionnaire

     (48K)
    To be filled out prior to each session each week to track treatment progress. Think over the last week (including today) and mark the answer that describes your experience. Available in the lobby as well.
  • File

    Outpatient Services Contract 2013

     (165K)
    A detailed discussion of my policies including appointments, cancelations, fees, insurance, records, and confidentiality.
  • File

    Quality of Life Questionnaire - WHOQOL-BREF.pdf

     (84K)
    To be filled out prior to the first session and again at the end of the treatment course. Think over the last week (including today) and mark the answer that best describes your experience.