Forms

FORMS FOR ADULTS: If this is your first time coming to my office, please download and complete the following relevant forms below, and bring them to your first session:

• Biographical Information – Intake Form – Adults (everyone must complete)

If you are also interested in nutrition, please download and complete the two forms below, in addition to the form above:

• Health Profile Questionaire
• 3-Day Diet, Exercise, and Mood Journal (print 3 copies)

Prior to your first session:

1. Print 3 copies 3-Day Diet, Exercise,and Mood Journal.
2. Complete 1 copy per day for 3 days.
3. When describing your meals, please be specific.  For example:  when describing your breakfast meal, instead of saying, "bacon, eggs, toast, and coffee", please provide details such as, "2-egg omelet with a sprinkle of cheese, 1-tablespoon green peppers, 2 strips of bacon, 2-slices whole wheat toast with one pat of butter on each, coffee with whole milk and white sugar".

FORMS FOR CHILDREN: If you are bringing your child in for counseling, please download and complete the following four forms and bring them to your first session:

• Biographical Information Intake Form – Adults
• Biographical Information Intake Form – Children

If you are also interested in nutrition, please download and complete the two forms below, in addition to the form above:

• Health Profile Questionaire
• 3-Day Diet, Exercise, and Mood Journal (print 3 copies)

Prior to your first session:

1. Print 3 copies of the 3-Day Diet, Exercise,and Mood Journal.
2. Complete 1 copy per day for 3 days.
3. When describing your meals, please be specific.  For example:  when describing your breakfast meal, instead of saying, "bacon, eggs, toast, and coffee", please provide details such as, "2-egg omelet with a sprinkle of cheese, 1-tablespoon green peppers, 2 strips of bacon, 2-slices whole wheat toast with one pat of butter on each, coffee with whole milk and white sugar".