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.
COUPLE’S CONFERENCE FORM
For couples attending the Annual Couple’s Conference
If you are interested in attending the upcoming Annual Couple’s Conference in November 2016, please complete and submit the following form or visit the website to register online.
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.
Please complete the front and back portion of the form along with the Disclosure Statement.
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.
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:
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.
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.
SPEAKER RESERVATION 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.
For therapists in need of supervision
This form is utilized for individuals who are seeking mental health supervision services.