Melonie Gale  MA,

LCPC, LMFT, LPCC, LMHC, NCC
Psychotherapy & Counseling for Adult Individuals & Couples

Helpful Forms...

If you're a new client, please complete the following forms and bring them to your first therapy session.

Client Counseling Intake Form Intake form
Client Counseling Agreement 

Below is the HIPPA Disclosure.  Please print out for your information. 

Client HIPPA Disclosure Hippa Form

     

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Release of Information Authorization to Disclose Information Form


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