Transformed Hearts Counseling Center, Inc. has many forms available below for new and existing clients, as well as therapists and those seeking to pursue speaking engagements.

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INTENSIVE FORMS


For individuals & couples participating in an intensive

All new intensive clients are required to complete the New Client Information Form and Disclosure Statement.  You are also welcome to complete the Intensive Insurance Statement Request Form, if needed. To access these forms, please click on the links below.

2019 Printable Intensive Client Forms Packet 2019 Online Intensive Client Forms

NEW CLIENT FORMS


For individuals, couples, & families

All new clients are required to complete the New Client Information Form, as well as the Disclosure Statement Form. To access these forms, please click on the links below:

2019 Printable New Client Forms Packet 2019 Online New Client Forms

GROUP MEMBER FORMS


For all new group members

All new group members are required to complete a New Group Member Participation Form as well as a Disclosure Statement. To access the forms, please click on the links below.

MEN’S FORMS | 2019 Printable Men’s Group Member Form | 2019 Men’s Online Group Member Form

WOMEN’S FORMS | 2019 Printable Women’s Group Member Form | 2019 Women’s Online Group Member Form

Please complete the front and back portion of the form along with the Disclosure Statement.

POLYGRAPH FORMS

For polygraph clientele

If you are interested in pursuing a polygraph examination, please review the following Polygraph Information Packet. To schedule and proceed with a polygraph examination, please complete the Polygraph Form listed below.

2019 Printable Polygraph Form

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RELEASE OF INFORMATION FORM

For clients to request records

This form is utilized for clients to provide or receive authorization to release personal and confidential information.  To access this form, please click on the link below.

2019 Printable Release of Information Form

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SPEAKER ENGAGEMENT FORM

For speaking seminars/conferences

Cory speaks at various events throughout the year.  If you are interested in reserving a date or a speaking engagement, please complete the Speaking Engagement Form. To access this form, please click on the link below.

2019 Printable Speaking Engagement Form

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SPLANKNA DISCLOSURE FORM

For clients interested in Splankna Therapy 

2019 Printable Splankna Disclosure Form

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SUPERVISION FORM

For therapists in need of supervision

This form is utilized for individuals who are seeking mental health supervision services.

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