Deer Valley Counseling
"Skills for Better Living"
Forms
Here are some useful forms. You will need the Adobe
Reader to view these files. 
Authorization for Release of Confidential Information
Adult Intake Packet
If you like, you can download, print, fill out, and bring these forms with you to your first session to save time.
- Client Information Sheet - Adult
- Payment Policy & Consent to Treat - Adult
- Notice of Privacy Practices
- Receipt and Acknowledgement of Notices- Adult
- Treatment Plan - Adult
Child Intake Packet
If you have made an appointment for your child (under age 18), you can download, print, fill out, and bring these forms with you to your child's first session to save time. You must come with your child the first time. If you are going to come in to see the counselor with your child, you must fill out an adult intake packet also. Everyone who goes in to see the counselor must fill out a complete packet.
- Client Information Sheet - Child
- Payment Policy & Consent to Treat - Child
- Notice of Privacy Practices
- Receipt and Acknowledgement of Notices- Child
- Treatment Plan - Child
Authorization for Release of Confidential Information
If you would like for Deer Valley Counseling to release confidential information about you or your child to someone else, you must authorize us to do so in writing using this form - Authorization for Release of Confidential Information. Download the form, print it out, fill it out, and then fax it to Deer Valley Counseling. You will have to call Sandra Nettles at 602.750.8051 for the fax number since we do not put that number on the internet. More information about the Deer Valley Counseling privacy policy can be found at Privacy.
Request for Copies
If you would like for Deer Valley Counseling to send you a copy of your file, you must request us to do so in writing using this form - Request for Copies. Download the form, print it out, fill it out, and then fax it to Deer Valley Counseling. You will have to call Sandra Nettles at 602.750.8051 for the fax number since we do not put that number on the internet. Please note that if more than one person was present at a session, then we will have to recieve an Authorization for Release of Confidential Information from each of the other persons present at the session before we can release the information for that session.