Keys to Living Professional Counseling from a Christian Perspective

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Jeanie Gardner, Secretary
(319) 377-2161
keystoliving@juno.com
Helpful Forms

If you're a new client, please complete the following forms and bring them to your first session.

  • Client Registration Form
  • Psychosocial History Form
  • Psychosocial History Form Adolescent 
  • Client Statement of Understanding, Consent & Bill of Rights Form

 If you would like your therapist to release information with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form:

  • Authorization to Release/Exchange Information Form

 
(Both Microsoft Word and PDF forms are provided for your convenience)


Client Registration Form  
Client Registration Form  
Psychosocial History Form  
Psychosocial History Form  
Psychosocial History Form Adolescent  
Psychosocial History Form Adolescent  
Client Statement of Understanding, Consent & Bill of Rights Form  
Client Statement of Understanding, Consent & Bill of Rights Form  
Authorization to Release/Exchange Information Form  
Authorization to Release/Exchange Information Form  

Note: To download Adobe Acrobat Reader for free, click here.


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