Client Forms
To complete registration to attend group meetings, several forms need to be completed for our records. Please verify which forms you need to complete by speaking to someone within the agencies. Once completed, the forms can be emailed or mailed to our facilities, though it is important to note that some forms require a valid signature which can be completed during the first meeting. Please verify with My Healing Place that your forms have been received to avoid any errors in or lack of processing.
To fill out these forms, simply select all of the text for the form and then copy it to the word processor on your computer (i.e. Microsoft Word, Microsoft Office, or Word Perfect). After completion, the form can be emailed in and then be signed (if needed) on a later date when meeting in person. You also have the option of printing out the form(s) to be filled out and then mailing them in.
Support Group Forms:
Adult Support Group Client Information & Registration Form
Adult Consent for Group Treatment Form
Child or Adolescent Support Group Client Information & Registration
Individual Therapy Forms:
Adult Individual Therapy Client Information & Registration Form
Adult Consent for Individual Therapy Treatment Form
Child or Adolescent Individual Therapy Client Information & Registration Form
Child or Adolescent Consent for Individual Therapy Treatment Form