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Pre-Registration Forms

//Pre-Registration Forms
Pre-Registration Forms 2018-10-15T15:04:44+00:00

Saint Louis Counseling Pre-registration Forms

For your convenience, our pre-registration forms are now electronically fillable from your computer. We ask that you complete, print and bring these forms with you to your first appointment.

Please Note: The intake forms are several pages. If you wish to have the ability to come back to filling out the form at a later date, please download the form to your computer, and the information you enter will be saved to your local computer. 

Due to HIPAA privacy, please do not send any of these forms electronically to our office. You MUST print from your personal computer and bring a paper copy with you to your first appointment.

Forms indicated with a “STAR” will be required at your first appointment.

Basic Info, Consent and Acknowledgement Forms

Acknowledgement of Receipt
Consent to Treatment Form
Basic Information and Agreement Sheet

Intake Forms

Only one of these two forms is required based on age of patient. If more than one person (i.e., family, spouse, partners, etc.) is seeking treatment, each person will need the appropriate form filled out.

Adult Intake Form
Child & Adolescent

Rights and Privacy

Rights & Responsibility
Notice and Privacy Practices

Call Us at
314-544-3800 or
Request An Appointment!

Please submit your information in the form below, and we will contact you soon to schedule an appointment. Thank you for your interest in
Saint Louis Counseling.

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