• Welcome to Olson Family Counseling

    Thank you for reaching out. This form will take approximately 10-15 minutes to complete. Please answer all questions as honestly as possible so we can best match you with the right therapist. All information is kept strictly confidential and protected under HIPAA. If you are experiencing a mental health emergency, please call 911, call or text 988, or call Colorado Crisis Services at 1-844-493-8255. Do not use this form in an emergency.
  • Date of Birth*
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  • Client Age Range*
  • If the child is under 12, are the parents currently legally married?
  • If the child's legal parents are not married, who has legal authority to make medical and mental health decisions for the child?
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  • If you indicate that one parent has sole legal authority to make medical and mental health decisions for the child, court documentation is required before services can begin.

    Please upload a copy of the applicable court order or Allocation of Parental Responsibilities (APR). Our Clinical Director will review the documentation to determine whether it is sufficient for consent to treatment. If additional documentation is needed, our office will contact you before scheduling services.

    Please note that primary physical custody or the other parent's lack of involvement does not necessarily mean one parent has sole legal decision-making authority.

  • I understand that services cannot begin until Olson Family Counseling has reviewed the applicable court documentation.
  • Gender Identity*
  • Preferred Pronouns*
  • Race/Ethnicity
  • Do you currently reside in the state of Colorado?*
  • Format: (000) 000-0000.
  • What type of therapy are you seeking?*
  • Are you interested in medication management services?
  • Insurance Provider*
  • Do you have reliable internet access for video sessions?*
  • How would you prefer to conduct your intake consultation?*
  • Do you have a specific therapist in mind?*
  • Which days are you generally available for sessions?*
  • What times of day work best for you?*
  • What type of therapy are you interested in? Select all that apply.
  • Have you been in therapy before?*
  • Are you currently seeing another therapist?*
  • How often are you currently using alcohol or substances?*
  • Have you experienced any thoughts of suicide?*
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