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New Client Forms

Youth & Adult Counseling

Adult 18+ Client Forms

Prior to your session, please click each link below to fill out forms. 

**Couples, please fill out separate forms**

If you prefer to download forms and print them out, please click on links below to upload forms.

*Note: Forms can be filled out by downloading with Adobe PDF format and clicking the 'Edit' button. Signatures can be added electronically by clicking on the 'Add Signature' button using the same PDF format.

Fill out New Client Intake Form to the best of your knowledge.

Please sign to acknowledge you have read and understood the Client Wavier Agreement and Cancellation Policy Update.

*COUPLES PLEASE FILL OUT SEPARATE FORMS*

Email completed forms along with a copy of your valid State ID OR Driver's License to:

info@courageousselfcarespecialists.org

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706-804-4240

Union City, GA 30291

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©2023 by Courageous SELFcare Specialists, LLC.

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