For more information:
(603) 247-4191 / drrobin@insightsgroup.net

Forms

INTAKE FORMS

New client information & consent for services

     To be completed for all new patients

Privacy notice

     To be completed for all new patients

Credit Card Authorization

     To be completed for all new patients

Adult – background & history

     To be completed by patients over the age of 18

Adult – permission to release information

     To be completed by patients over the age of 18

Couples – background & history

    To be completed by each member of the couple

Minor – background & history

     To be completed by the parents or guardians of children under age 18

Minor – permission to release information

     To be completed by the parents or guardians of children under age 18

Coaching Intake Form

    To be completed for all new coaching clients
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