All Forms

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.

All documents are available in PDF format. If you do not have Adobe Acrobat installed, please click here to obtain a free adobe Reader.

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.

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:

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.

ONLINE FORMS (For both men & women) | Online Group Member Form

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.

Online Release of Information Form

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.

Printable Polygraph 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.

Printable Speaking Engagement Form

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SPLANKNA DISCLOSURE FORM

For clients interested in Splankna Therapy

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.

Printable Supervision Agreement

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