Intake Forms

 
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    Michael E. Holtby, LCSW, BCD

    DenverPsychotherapy.com

CLIENT INTAKE FORMS

 

Confidentiality:

All intake forms are confidential, and only the therapist has access to them. The forms are protected by two different passwords and special software to view them. The company that provides the service compares the security to the level of credit card transactions. Once the forms are submitted they are downloaded within a few days, and then your submission is deleted from cyberspace. If you are still concerned, fill them out only after you print them-- and then mail them in.

Intake Forms for Regular Clients:

There is one form to fill out, and two to read (to sign as read and understood at the first session). After completing this form please e-mail me and let me know its waiting for me to download.

To Access Intake Form 

Diversion Program Intake Forms:

For this program you will need to go to four different links, and complete all of the following. After completing this form please e-mail me and let me know its waiting for me to download.

Part 1:

    Basic Client Information

    Patient Rights Legal Release

    Life Change Check List

Part 2:

    Depression Check List

    Anxiety Scale

    Alcohol Abuse

Part 3:

    Survey of Social Supports

    Relationship Satisfaction Scale

Part 4:   

    Abuse Checklist

    Sexual Addiction Screening Test: Straight Version

    Sexual Addiction Screening Test: Gay Version

 

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Last messed with May 27, 2002

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.
holtby@DenverPsychotherapy.com