Keys to Living Professional Counseling from a Christian Perspective

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Kathy Shoesmith, 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 you convinence)


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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