Intake Forms

The intake package (PDF) includes: CCFT client information form, information about CCFT, consent for services form, and agreement of parents/guardians for divorced families. The CCFT Privacy Practice describes how we protect your health information, how it is disclosed, and how you can get access to this information. Click the appropriate link to download and print. All of our forms have been updated on March, 2019.

Please use ONLY black bold ink on all paperwork.

Intake Packet

Notice of Privacy Practices Short Version  (This is for you to read over.  You do not need to print this document.)

Telehealth Informed Consent Form         


Therapist Disclosures

Your therapist has provided a disclosure which is part of your CCFT intake package. Click on your assigned therapist’s name to download and print. Please bring all completed forms to your first appointment

Jenny Fisher

Helena Hauge

Jeffrey Weist

Autumn Russell

Sharon Booker

Golnar Ansari

Cory Staton

Stacie Flynn

Garth Retallick

Jenny Berry

Lisa Kelly

Patrick Barry