Debbie Gross, LCSW, Ltd.

     Individual, Marital & Family Therapy

Forms

Before the first session, you will receive an email with information about the appointment and forms that are needed. Please click on the buttons below to access the forms. You can either print them or fill them out online and email them back to me or bring them to your first session.

INTAKE & INSURANCE FORM

Please download the form above and fill out the intake completely. Please fill out the insurance form if you would like me to look into billing your insurance company for you (mandatory for 

in-network clients).

ADULT HISTORY FORM

One form is required for each adult that I will be seeing. Please download the form above and fill out with as much detail as possible to ensure I understand your concerns and what brings you to counseling.

CHILD HISTORY FORM

If your child is under age 18, please download the form above and fill out with as much detail as possible to help me in understanding your child's needs and your concerns.

MINOR 12-17 PARENT CONSENT FORM

For children ages 12-17, download and print this form and bring it to the session. I will go over it with you and your child so he or she can authorize the appropriate level of communication between parents and me.

CREDIT CARD AUTHORIZATION 

Download the form above and fill out for your first session. This is required for all new clients.

CONSENT FOR INFORMATION

Download the form above for release of information for any collaborative communication between myself and other professionals.

PRIVACY PRACTICES

FORM

Please download and read this form. You need only to print out page 4 and bring to your first session. This form is needed at the beginning of every new year as well.

FAMILY/COUPLE CONFIDENTIALITY 

When working with couples or families, it is important to understand the complexity of confidentiality in this setting. I will go over this with you at our first session so each person feels comfortable with the counseling process.

What clients are saying

Debbie is very laid back, and makes me feel comfortable.

JD, age 12