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INTAKE PAPERWORK

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INTAKE PACKET

Our Intake Paperwork Packet. All sections pertaining to the client must be complete. Any questions regarding intake paperwork can be directed to (614) 329-8862 or admissions@moderntherapyohio.org
This item must be completed and returned to admissions@moderntherapyohio.org or a Modern Therapy office for any counseling sessions to take place.

MODERN THERAPY PAPERWORK

Individual Pages for Client Convenience

PATIENT REGISTRATION

CONSENT TO TREATMENT

HIPPA AGREEMENT

CONSENT FOR CONTACT

CREDIT CARD AUTHORIZATION

NO SECRETS POLICY

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