Forms Forms may be printed, completed and brought to your initial consultation. Forms are also available in the office for your use. Please allow 15 minutes prior to your initial appointment time to complete these forms. Click on the form you need. Some forms can be filled in and printed right from your computer for your convenience.

Patient Data Form

Obtains patient information.


Notice of Privacy Practices

Informational sheet for the client’s use.


Consent of Treatment

Provides consent to the therapist and Cornerstone Counseling Center to treat you.


HIPAA Consent Form

Outlines how we may use your Protected Health Information (PHI).


Office Policies

Details many of Cornerstone Counseling Center’s policies about therapy.

Authorization for Release of Information

Provides consent to Cornerstone Counseling Center to release information to outside parties such as insurance companies, physicians or referral sources. NO information about you or your treatment will be released without your consent.


If the client is under 14 years of age, please have a parent or guardian sign.

® 2013-2015  \\   Kim W. Dalton. All Rights Reserved   \\  Web Design by