For your initial appointment with your counselor, please print off and complete the following forms:

Initial Intake Form

Good Counsel Intake Form

Disclosure Forms

Please complete the form for your counselor:

Chuck Fallon, LPC

Other Forms

The following forms are used as needed by recommendation of your counselor:

Release Agreement

Child Confidentiality Agreement

No Harm Agreement – Minor

No Harm Agreement – Adult

Reduced Rate Package Forms

These forms are used for Reduced Rate Packages (click here to read more about Reduced Rates):

Reduced Rate Package Application

Church Partner Financial Agreement Form