Dr. Rebecca Howard

Client Forms

Once you have decided to begin services, please choose the forms necessary to read over.

Please complete them prior to the session.

If you have questions about any of the information, please bring those questions with you to our session.

Client Information: This provides me with your basic contact and referral information.  Be sure to note confidentiality considerations.  

 

Client Information Form.pdf Client Information Form.pdf
Size : 0.091 Kb
Type : pdf

Consent Form and Mandatory Disclosure: By law, all psychologists and psychotherapists use consent forms that provide information regarding credentials, payment policies, and legal and ethical issues.  This form must be agreed to and signed in order for us to work together.  Do not sign the form until you feel comfortable with the information, and be sure to let me know of any questions you might have about it. 

Child Developmental Questionnaire: This form provides me with a lot of background information about your child and family.  Some people like to spend a lot of time on this questionnaire, while others are brief or prefer to communicate information verbally.  Feel free to answer it at your level of comfort.  If parents complete this form regarding their child, the information will typically be shared with their child.

For those clients interested in family therapy, please choose Life History for each adult in the family that will be involved in family therapy and a Developmental History for each child or adolescent. For families with multiple children, you can complete one form completely and write refer to other history for areas where the history is the same. 

 

Developmental History Questionaire.pdf Developmental History Questionaire.pdf
Size : 0.212 Kb
Type : pdf

Life History Questionnaire - Adult: This form provides me with a lot of background information about you.  Some people like to spend a lot of time on this questionnaire, while others are brief or prefer to communicate information verbally.  Feel free to answer it at your level of comfort.

Life History Questionaire.pdf Life History Questionaire.pdf
Size : 0.143 Kb
Type : pdf
 
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