Forms

New Clients

Please fill these forms out prior to your first appointment. This will help us reach your goals in a much timelier manner. Thank you!

New Client Form

This form has all of your identifying information and your insurance information; you will also need to bring your insurance card if you have it, so we can make a copy.

Client Intake Adult

This set of forms helps us to answer questions we may have about many different areas of your life, from your childhood to your current functioning. Although it is long, its detailed nature allows us to make sure we don’t have to ask you too many questions during our sessions, so that we may focus more on your goals and your solutions. This intake also includes a complete alcohol and drug screening. The time it takes to fill out this inventory is unique to you, but the time you take to fill it out is very much appreciated.

Child Intake

This is a set of forms has been adapted to account for a child’s age and reading level and asks child-appropriate questions. Please help your child fill this out. There are no right or wrong answers.

Burns Anxiety Inventory

The Burns Anxiety Inventory was developed by David Burns to help screen clients for anxiety symptoms. The screening is designed as a tool to assist you in determining how badly the listed symptoms or problems have bothered you in the past. We use this to help us determine if these symptoms could be part of the things standing in the way of reaching your solutions. The inventory takes about 5 minutes and is greatly appreciated.

Beck Depression Inventory

The Beck Depression Inventory is a widely used self-report, 21 multiple choice questionnaire used to assess a person’s depressive symptoms. This tool was developed by Dr. Aaron T Beck.  This tool helps assess how badly these symptoms might affect a person’s life. We use this tool to help us determine if these symptoms could be part of the things standing in the way of you reaching your goals. The inventory takes about 5 minutes and is greatly appreciated.

Policies and HIPPA

This explains the policies of Gapp Counseling Services and the Health Care Information Privacy Policy Administration. Please read the form; it will help you understand details on privacy which will be discussed during your initial session. 

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Debra Gapp,
Jan 6, 2014, 11:05 PM
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Debra Gapp,
Jan 6, 2014, 11:03 PM
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Debra Gapp,
Jan 6, 2014, 11:05 PM
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Debra Gapp,
Jan 6, 2014, 11:04 PM
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Debra Gapp,
Aug 16, 2017, 11:28 AM
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Debra Gapp,
Jan 6, 2014, 11:04 PM
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Debra Gapp,
Feb 26, 2014, 12:50 PM
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