Broward Center for Counseling – Intake Forms

Now that you are ready to begin in therapy our intent is to help you feel comfortable and secure with our office and your therapist. Initial paperwork is a necessary component to our providing quality care. Prior to your first appointment please complete either the adult or minor intake form which will ask for general information as well as specifics of your history and your reason for seeking therapy at this time. Additionally we need you to read and sign forms acknowledging that you understand our cancellation policy and giving us permission to contact you. When a minor is engaged in therapy we will need a form signed by each parent agreeing to treatment.

We will provide you with and require your signature on a HIPPA form as well as a form that specifically addresses your financial responsibilities for treatment.

It is important that you understand that all the information you provide to us, as well as any information we add to your file, is strictly confidential. Only with a signed release, directly from you, or a court order, can this information be obtained by a third party. The Release of Information form is included for your convenience. This form is only necessary if we need to consult with another professional on your behalf.

All counseling sessions are approximately 50 minutes in length and are by appointment only. There is a strict 24-hour cancellation policy in which you will be charged in full for any session not canceled with at least 24 hours advanced notice. The health and safety of everyone who comes to our office is important. Please be mindful of any cold or flu like symptoms and know that we will always switch your appointment to a Telehealth session even on short notice.

If at any time you have questions regarding office policy or your financial responsibilities feel free to speak with one of our managing therapists or our office staff.