Client Intake Form
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  • Client Information

    A seperate form is needed for each person coming to counseling
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  • Prior Marriages

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  • List all children

    Living with you or not
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  • Payment Card Authorization

    I authorize Donnie Van Curen to charge the card below for $175 including phone sessions and any other charges(books,clasess,etc) we both agree upon as stated in the Professional Disclosure Statement
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