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:

To Read:

Client Rights and Responsibilities

To Fill Out (Optional):

Authorization for Release

Client Information Form

HIPAA

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

Self-Pay Form

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

Consent for Treatment of Minors

Read and fill out if you are scheduling a minor (under age 18) for counseling.