Forms

New Client Forms

Children & Adolescents:

  • Forms for new in-office clients under the age of 18:  Intake Paperwork: Minors
  • Forms for new online-therapy clients under the age of 18: Intake Paperwork (Online Therapy): Minors
  • Please Note: Parent/Legal Guardian is responsible for minor and non-minor Children. If parents are divorced, Mason Family Counseling will not act as a mediator in settling claim/payment issues. The parent that brings the child in for treatment is responsible for payment. Legally, we are not able to bill ex-spouses, regardless of divorce decree.
  • Legal guardians can elect to use a payment authorization form or pre-pay the estimated amount due at the time of the session. Otherwise, guardians must accompany their children into the building to take care of their co-pay before the session. Co-pays must be taken care of prior to the appointment, or client will have to reschedule.

Adults:

Medication Evaluation / Management: