• Life Training logo

    Counseling Client Intake Form

    Please complete all parts of all sections
  • SECTION 1: CLIENT INFORMATION

    Thank you for providing us this important information about yourself
  •  /  /
    Pick a Date
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  •  -
  • Body, Spirit, & Soul

    This section is to be answered by the client, even if under 18 years of age
  • Family of Origin

  • Current Issues & Concerns


  • Section 1 Confirmation

  • SECTION 2: CLIENT AGREEMENT

    Thank you for reading and completing each section as indicated
  • Counselor Credentials

  • Client Confidentiality

  • Client Participation

  • Section 2 Confirmation

  • SECTION 3: FINANCIAL AGREEMENT

    Thank you for reading and completing each section as indicated
  • Regular Session Fees

  • APS Temperament Profile

  • Cash-Pay Only

  • Payment Methods

  • Late Cancellations and No-Shows

  • Returned Check NSF Fee

  • Credit Card Authorization

  • Credit Card Authorization Form

    https://lifetrainingcounseling.org/credit-card-authorization-form/

  • Section 3 Confirmation

  • Should be Empty:
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