Intake Forms for Children and Adolescents 

Let's get the paperwork out of the way...

All of the child and adolescent intake forms can be downloaded from this page. Please click on each link below, print out the corresponding intake form, complete the first two forms, and then bring them with you to your first appointment.

First, click on the following link for the Adult Intake Form:

Child and Adolescent Intake Form - Click Here

Second, click on the following link for the Consent to Treatment Form

Consent for Treatment Form - Click Here

Third, read the LifeLine Counseling Policies and Procedures. This document provides you with important information about our practice and service to you. It does not need to be printed out or signed.

LifeLine Counseling Policies and Procedures

Finally, read the HIPAA notice regarding your rights to privacy under state and federal law. This document is provided to you in accordance with the law. It does not need to be printed out or signed.

HIPAA Notice

Done? Please remember to bring the Intake and Consent for Treatment Forms to your first appointment.

Finally, you call for an appointment at 440.942.0100. Or, if you prefer, you can request an appointment using an email form. Please note that your use of the email form may not be confidential due to the nature of the web, and that you assume all liability for the information provided.

New Patient Appointment Request Form