Hope starts here.

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Thank you so much for connecting with us at the Center for Modern Family Dynamics. In preparation for your first appointment with us we have some important paperwork for you to fill out and bring with you. These forms will explain our obligations and your protection in regard to confidentiality as well as explore the therapeutic issues that are of concern to you. Basic demographic information will also be a part of what we need for proper clinical records. Every question is important, so please respond to all of the items on each form regardless of any redundancies. Even if an item does not apply to you, mark it as such so that we are sure the question was not mistakenly left blank. Any missing information or unanswered questions will be addressed in our first session to be sure our records are complete.

There are four different sections to the right (if you are viewing this site on a mobile device, they will be listed at the bottom of this page). Go to the section that indicates the type of services desired, Adult (individual), Child, Family, or Couple/Marital. Each will provide 6 or 7 documents in PDF format for you to download/print. Alternatively, you can download a zip file containing all of the appropriate paperwork by clicking the links below. Also, depending on who you will be seeing, choose the individual “Practices and Policies” PDF to download/print to accompany the general intake paperwork. When choosing Family or Couple/Marital intakes be sure to print and complete an “Extended Adult Intake” and “Check List of Symptoms” for each adult (usually 2) who will be attending sessions, all other forms may be filled out conjointly.

If you do not have access to a printer please contact CMFD and we will provide hard copies of all of the necessary forms for you to complete. You can make arrangements to pick them up, fill them out at home and bring them when you come for your session OR arrive 35-40 minutes early to take care of the paperwork before your appointment.

Practices and Policies

Intake Forms