Intake Forms and Policies

The following forms are used in our practice. It may be helpful to complete them before you come in for your first session. If you have any questions about these forms, we can discuss in session.

Please choose the specific form for your therapist.

Mary Herzog, PhD.Mary Herzog, PhD

Intake forms / Adult (Download to print full set)

  • LFT Therapy policies and procedures
  • Privacy Practices
  • Receipt of privacy practices
  • Client intake
  • Map and Directions

Intake forms / Child (Download to print full set)

  • LFT Therapy policies and procedures
  • Privacy Practices
  • Receipt of privacy practices
  • Child intake form
  • Map and Directions
  • LFT Therapy policies and procedures
  • Privacy Practices
  • Receipt of privacy practices
  • Client intake (Both partners complete please. Duplicate copy included in the set.)
  • Map and Directions

Kirk Andrews TherapistKirk Andrews,
MA, LMFT, BC-DMT

Intake forms / Adult (Download to print full set)

  • LFT Therapy policies and procedures
  • Privacy Practices
  • Receipt of privacy practices
  • Client intake
  • Map and Directions

Intake forms / Child (Download to print full set)

  • LFT Therapy policies and procedures
  • Privacy Practices
  • Receipt of privacy practices
  • Child intake form
  • Map and Directions
  • LFT Therapy policies and procedures
  • Privacy Practices
  • Receipt of privacy practices
  • Client intake (Both partners complete please. Duplicate copy included in the set.)
  • Map and Directions

Additional Individual Forms

  • Retainer for Legal Matters
  • How to Make the Most of your Couples Therapy