The initial Client Profile Intake packet must be completed prior to the initial session. Please email the packet to mageemadrycounseling@gmail.com prior to your initial session. It is imperative the packet is received prior to the initial session to allow a thorough review of information provided in preparation for the initial session.

The HIPPA Notice of Privacy Rights Disclosure is not to be included in the Client Intake packet it is for your review. You may print a copy if you would like for your records.

Client Intake Packet

Intake Client Profile Intake Form

Telemental Health Consent Form

Authorization for Release of Information

HIPPA Notice of Privacy Rights Disclosure

Your privacy is of the utmost importance to Magee Madry Counseling Services, LLC. Our agency complies with both federal and state laws related to patient privacy.

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    ADDRESS

    63739 street lorem ipsum City, Country

    PHONE

    +12 (0) 345 678 9

    EMAIL

    info@company.com