WESTERN RESERVE COUNSELING
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FORMS

Forms for New Clients


HIPPAA Notice of Privacy Practices
Consent (In-office)
Consent (Telehealth)
Health Insurance/Fee Agreement
Depression Screener - Adult
Depression Screener - Adolescent

Additional Forms if Needed

RELEASE OF INFORMATION

​Phone: (440) 822-8248
3880 S Washington Ave
Suite 233
​Titusville, FL 32780 

Fax: (440) 377-6490
  • Home
  • About
  • Services
  • Our Therapists
  • Contact
  • Make a Payment
  • Resources
  • Forms