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Client Forms
Most forms are in PDF format; you will need the current version of Adobe Reader in order to read the forms. If you don't already have Adobe on your computer it's available as a quick, free software download.
Click the link to download the software. |
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Download and save the following required forms to your computer.
Both new and returning clients must complete and return all printed and signed forms.
1) The Privacy Policy (signed)
2) One signed copy of your therapist's Disclosure Statement
3) The Client Information form (2 pages)
4) Spanish version of Privacy Policy and Disclosure Statement are included with Spanish version of Client Information Form
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FORM NAME |
PDF |
Client Information Form
(English)
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Client Information Form
(Spanish)
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Client Satisfaction Survey
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Rick Howell, Th.M., LMHC
Disclosure Statement
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Dr. Mary Binswanger, Ed.D., LMHC
Disclosure Statement
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Diane Brantley, LCSW
Disclosure Statement
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Dr. Dennise Lawry
Disclosure Statement
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Melissa Miller, LCSW
Disclosure Statement
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Dr. Sam Miller, Th. D., LMHC
Disclosure Statement
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David Preston, P-LCSW
Disclosure Statement
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(Please keep copies of the Privacy Policy and the Disclosure Statement for your records.)
If possible, mail to or drop off the completed and signed forms at the Bee Ridge office,
in advance of your first session so your therapist has time to review them.
The address is:
ATT: (insert your therapist's name)
Samaritan Counseling Services of the Gulf Coast, Inc.
3224 Bee Ridge Rd.
Sarasota, Florida, 34239
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