Counseling

Counseling Agreement Form
(click image)

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Counseling Form

Counselor Name

Counselor Email

Address on file

check the box if you've entered your mailing address before. we'll have it on file.

Address

City

State

Zip Code

Counselee Information

Counselee Name

Date of Counseling Session

Appointment time

This is our...check appropriate box

1st session - $602nd session - $603rd session - $30...counselee pays $30

Additional Commentsdo not include sensitive information. this form is seen by several staff members.

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