Forms

Intake Form

Please follow the instructions to complete this form prior to attending your first appointment.  If you are unfamiliar with your insurance benefits, please contact your insurance company to learn about your coverage.

Download the Intake Form (PDF)

Privacy Practices

This is a description of how your Protected Health Information (PHI) is used at our office.

Download Privacy Practices (PDF)

Informed Consent

This form describes your therapeutic relationship with Gahanna Counseling, LLC.  Please read this form carefully and discuss any questions with your therapist. Your signature is required on the last page.

Download the Informed Consent (PDF)

Telehealth Informed Consent

This form describes the use of telehealth, electronic service delivery, and technology-assisted approaches in your therapeutic relationship with Gahanna Counseling, LLC.  Please read this form carefully and discuss any questions with your therapist. Your signature is required on the last page.

Download the Telehealth Informed Consent (PDF)

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All rights reserved.

540 Officenter Place, Suite 180
Gahanna, OH 43230
Phone (888) 336-1772