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Initial Intake Documents

**NOTE: Any new patient requesting a teletherapy appointment for their initial session must complete all of their intake paperwork and email it to officemgr@akronfamilyinstitute.com 48 hours or more prior to their appointment. Otherwise, you will be expected to attend your initial appointment in person. Thank you!

To Fill Out (Optional):

Fill out if you would like your therapist
to talk to a doctor, psychiatrist, etc. 

Fill out if you are not using insurance and are paying out of pocket. Your therapist will discuss a self-pay rate with you. 

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