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  • Services
    • Relationship Counseling
    • Individual Therapy
    • Children and Teens Counseling
    • Grief and Loss
    • Mom Squad
    • EMDR: Eye Movement Desensitization and Reprocessing
    • Groups
  • Contact
  • About
    • Meet The Executive Director
    • Meet the Team
  • Media
  • Careers
  • Events
  • Intake Forms

SCHEDULE APPOINTMENT
  • Services
    • Relationship Counseling
    • Individual Therapy
    • Children and Teens Counseling
    • Grief and Loss
    • Mom Squad
    • EMDR: Eye Movement Desensitization and Reprocessing
    • Groups
  • Contact
  • About
    • Meet The Executive Director
    • Meet the Team
  • Media
  • Careers
  • Events
  • Intake Forms

Intake Forms

Please print intake forms and bring with you to your first appointment. This will allow you the most time possible in your session with your counselor.

Adult Intake

  • Adult Intake
  • GAD-7 Assessment
  • PHQ 9 Questionnaire 
  • Credit Card Agreement Service
  • Agreement For Service Form
  • Telehealth Consent Form

Minor Intake

  • Minor Intake 
  • Parents Consent for Treatment 
  • Credit Card Agreement Service
  • GAD-7 (Adolescent)
  • PHQ 9 (Adolescent)
  • Agreement For Service Form
  • Telehealth Consent Form

Grant Funded Intake

  • Adult Intake
  • GAD-7 Assessment
  • Edinburg Postnatal Depression Scale (Male and Female. Does not need to be pregnant)
  • Credit Card Agreement Service
  • Agreement For Service Form
  • Telehealth Consent Form

Contact Information

1-530-887-1300
[email protected]
Auburn (Admin & Services): 265 Nevada Station, Auburn, CA
Roseville (Services): 720 Sunrise Avenue, Suite. 200C, Roseville, CA

Quick Links

  • Mom Squad
  • EMDR
  • Grief and Loss
  • Relationship Therapy
  • Children and Teens
  • Groups
  • Individual Therapy

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