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Forms

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Please select your related category to download and complete prior to appointment.

Click here for new client online registration and scheduling.

All Patient Intake Forms

  • PDF icon Credit Card Authorization and Consent
  • PDF icon Notice of Privacy Practices
  • PDF icon Teleheath Video-Conferencing Agreement

Adult Patient Intake Forms

  • PDF icon Intake Questionnaire
  • PDF icon Receipt and Acknowledgment of Notice of Privacy Practices & Therapy Informed Consent

Couples Intake Forms

  • PDF icon COUPLES QUESTIONNAIRE

Family Intake Forms

  • PDF icon Confidentiality Agreement for Couples/Family Therapy

Minor Patient Intake Forms

  • PDF icon Adolescent Intake Questionnaire
  • PDF icon Adolescent Privacy Policies
  • PDF icon Agreement for Collaterals
  • PDF icon Consent To Treat A Minor
  • PDF icon Credit Card Authorization and Consent (Minor)
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Note

I am doing telehealth only at this time due to COVID-19.

Please do not hesitate to contact me to set up an appointment. I can be reached via phone or email, however, please keep in mind that email is not a confidential form of communication.
I look forward to hearing from you. 

443.535.3130
410.630.3744
Baltimore, Maryland
carolyn@karollcounseling.com
Copyright © 2018 Carolyn Karoll