The Place Within Counseling

916-772-6158

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    • Home
    • About
    • Contact and Location
    • Meet Our Counselors
    • New Client Forms

916-772-6158

The Place Within Counseling
  • Home
  • About
  • Contact and Location
  • Meet Our Counselors
  • New Client Forms

New Client Forms

For Your Convenience

All our new client forms are fillable and printable.

For Adult Clients

New Adult Client Form (pdf)Download
Information For Client (pdf)Download
Credit Card Billing Form (pdf)Download
HIPAA Notice (pdf)Download
Informed Consent (pdf)Download

For Clients Under The Age of 18 (Signed by Guardian)

New Minor Client Form (pdf)Download
Consent To Treat A Minor (pdf)Download
Information For Client (pdf)Download
Credit Card Billing Form (pdf)Download
HIPAA Notice (pdf)Download
Informed Consent (pdf)Download

Copyright © 2022 The Place Within Counseling - All Rights Reserved.


All Associates and Trainees are under the supervision of licensed therapists Gary Henderson LMFT#7053 and Alexis Marson LMFT#80115

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