JASON M. ADAMS, LPC, NCC
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Intake Forms

Please read the following document prior to your initial appointment:
Privacy Notice
File Size: 87 kb
File Type: pdf
Download File


Please print and complete the following forms prior to your initial appointment:
Information & Consent
File Size: 88 kb
File Type: pdf
Download File

Medical History
File Size: 48 kb
File Type: pdf
Download File

Intake Form
File Size: 58 kb
File Type: pdf
Download File

Social History
File Size: 51 kb
File Type: pdf
Download File


Please print and complete the supplemental consent form below only if it applies to you. The Distance Counseling form is for clients receiving counseling services electronically (email, online chat, phone, and/or video conferencing).
Distance Counseling Consent
File Size: 71 kb
File Type: pdf
Download File

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  • Home
  • About
  • Services & Fees
  • Resources
  • Contact