Genuine Heart Counseling, LLC

For A Child Client

The forms below support all of us during our time together. I realize that some of these are lengthy and appreciate the time you take in reading and filling these out.

Please click on the links below, print the forms, fill them out and bring them to our first session.

Informed Consent & Disclosure Statement

Includes information about my training and credentials, the limits of our relationship and your rights as a client.

Statement of Fee Policy

Includes information about extra phone calls, auxiliary services, and emergencies, as well as scheduling and cancelations.

Child Information Form

Includes information about your present concerns regarding your child, his or her mental and medical health including significant aspects of the pregnancy or birth, your child’s strengths, and your goals for therapy. This provides me with helpful information about your situation and provides you an opportunity for a wider perspective. It can also bring to light certain aspects you may have forgotten about or started to take for granted.

Parent Information Form

Includes information regarding your own struggles as they relate with this situation and gives you an opportunity to reflect on your strengths as a parent and your personal choices for self-care, as well as request specific support around common parenting challenges. Also includes information on larger life issues that may be impacting this situation like a chronic illness, a major injury or substance use.