Ker Cleary, Clearheart Counseling
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Counseling Intake Forms

You can print and fill out these forms prior to our meeting if you'd like, or I will supply copies when we meet. I suggest you print a copy of each for your records. I need a completed copy of the Permission to Treat, Client Information, Financial Agreement and Credit Card Authorization. We will go over them in our first session.

1) Professional Disclosure

2) Informed Consent

3) Permission to Treat

4) Client Information

5) Financial Agreement

6) Credit Card Authorization

Download Past Newsletters from Ker Cleary:

Doorknob Gazette Fall 2008.pdf

Doorknob Gazette Summer 2008.pdf

Doorknob Gazette Spring 2008.pdf

Doorknob Gazette Winter 2007.pdf

Doorknob Gazette Fall 2007.pdf

Doorknob Gazette Summer 2007.pdf

Doorknob Gazette Spring 2007.pdf

Doorknob Gazette Winter 2006.pdf

Doorknob Gazette Fall 2006.pdf

 

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• Phone: 541.349.0595