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Forms

The forms below are to be completed before your first session with one of our counselors.  You can download/print these and complete them prior to your first appointment to expedite the process.

Family Information Packet
Explains policies and procedures of The Amelia Center. Retain for your reference.


The following forms are required for all families:

  1. Exceptions to Privacy  (Microsoft Word version)  (PDF version)
    Complete one form for your family.  Must be signed by the legal guardian of any minors attending counseling.

  2. Family Questionnaire (Microsoft Word version)    (PDF version)
    Complete one form for your family.

  3. Reaction Forms
    -
    Adult Form (Microsoft Word version)  (PDF version)
    One form needs to be completed for each adult attending counseling.  (Including guardians of children
    attending counseling.)

    - Child/Teen Form (Microsoft Word version)  (PDF version)
    One form needs to be completed for each child or teen attending counseling.

 For Existing Clients

Click here to submit your Message of Hope.



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