Alliance Counseling, LLC
928.252.1387 or 360.943.6642

Alliance Counseling, LLC 928.252.1387 or 360.943.6642Alliance Counseling, LLC 928.252.1387 or 360.943.6642Alliance Counseling, LLC 928.252.1387 or 360.943.6642
  • Meet David Clegg
  • Services & Crisis Help
  • Contact Us
  • Resources
  • Payments
  • Intake Forms
  • More
    • Meet David Clegg
    • Services & Crisis Help
    • Contact Us
    • Resources
    • Payments
    • Intake Forms

Alliance Counseling, LLC
928.252.1387 or 360.943.6642

Alliance Counseling, LLC 928.252.1387 or 360.943.6642Alliance Counseling, LLC 928.252.1387 or 360.943.6642Alliance Counseling, LLC 928.252.1387 or 360.943.6642
  • Meet David Clegg
  • Services & Crisis Help
  • Contact Us
  • Resources
  • Payments
  • Intake Forms

Intake & Consent Forms

 


Arizona Patient Forms

AZ Informed Consent 2022 correct (pdf)Download

Washington State Patient Forms

WA Informed Consent 2022 correct (pdf)Download

Forms for Patients in Both Arizona and Washington State

2022 Telehealth Consent (pdf)Download
Privacy Practices 2022 (pdf)Download
Release of Benefits 2023 (pdf)Download
General Intake Information (pdf)Download
Treatment Goal (pdf)Download

Adult Patient History for Arizona & Washington Patients

alliance counseling supplemental forms email (pdf)Download

Child History for Arizona and Washington State Patients

child psychosocial report 7-2-12 (pdf)Download

Consent to Exchange Info for Arizona & Washington Patients

Consent to Exchange Info 2022 (pdf)Download

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