Forms

Please print, fillout and bring the Intake form and Disclosure form on your first appointment. You only need to bring these two forms.

For couples, you each need to fill out a separate intake form but you can both sign the same disclosure form. Thanks very much

Intake Form

Disclosure Form

The HIPPAA Disclosure Notice describes your privacy rights
HIPAA Disclosure Notice

Release of Information

Welcome/Overview

Tel. 651.439.2059
Email. info@christianheartcounseling.com

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