Switch to Accessible Site
Navigating Life's ChallengesYou don't have to do it alone.
Couple Therapy Session

Client Forms for first appointment

1.  For your convenience I have provided the Client-Therapist Agreement form required for you to download, read, sign and bring to your first appointment.  If you cannot print it, please read prior to your appointment and a copy will be provided for you at that time.

Agreement and Consent
Active Counseling

2.  The following HIPAA form below needs to be read regarding the Health Information Privacy Act (HIPAA)

HIPAA privacy disclosure
Active Counseling
**This is to read only, you do not need to print the HIPAA** 

3.  The Secure Client Log-In  below can be utilized to provide initial information and in no way obligates you or Active Counseling Center, LLC to enter into a client-therapist agreement. .  It is a privacy compliant secure server where you can register.   Just click on the link...

Secure Client Login
Active Counseling

You will be able to create your own user ID and password to communicate via a secure web portal.  There is a biographical questionnaire to be completed as well through this Login site.

Please contact the office if you have any questions regarding these forms.  We will review this on your first appointment as they are required in order to provide services.  Thank you.

Below is the form regarding group therapy only:
Consent for Group Therapy
Active Counseling
**Please print this form ONLY if you are attending one of the therapy groups.  Thank you.