Client Forms

Your counseling session time is very important.  Please fill out these forms prior to your initial session to prevent cutting into our time together.  Please bring them with you to your appointment.

FOR AN INDIVIDUAL SESSION, BRING:

          1. Your counselor’s Disclosure Statement

          2. Individual Client Form

          3. Notice of Privacy Practice

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For a Couples/Marriage session, bring:

          1. Your counselor’s Disclosure Statement

          2. Couples Client Form

          3. Individual Client Forms (1 for husband & 1 for wife)

          4. Notice of Privacy Practice

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 For a Child/Adolescent session, bring:​

          1. Your counselor’s Disclosure Statement

          2. Minor Client Form

          3. Notice of Privacy Practice

Click on the links below for the forms.

Laura Ketchie’s Disclosure Statement

Vincent Ketchie’s Disclosure Statement

Individual Client Form

Couples Client Form

Minor Client Form

Notice of Privacy Practice

Telemedicine Informed Consent Form

     Sometimes, individuals or churches choose to sponsor clients and help pay for sessions. Below are the additional forms needed:

Benefactor Payment Agreement

Church Partnership Agreement

     At times, a client may wish for us to speak with a third party about them.  In order for us to do this, the client must give us written approval.  Below is the form to be fill out, signed, and returned to us for this instance.

Release of Information Consent