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Charmaine Solomon, LPC. RPT.
Solomon Family Services
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Forms


If you are a new client please complete the following forms, and bring them to your first session.  All forms are supplied in both Word and PDF format so you may chose which one you would prefer to print from.
  • SFS Counseling Services, Policies and Informed Consent Form 
  • Client Intake - Please complete appropriate form - either Child or Adult

SFS Counseling Services, Policies and Informed Consent - Word

SFS Counseling Services,  Policies and Informed Consent - PDF

Client Intake - Adult Form - Word 
Client Intake - Adult Form - PDF

Client Intake - Child Form - Word

Client Intake - Child Form - PDF


If you would like me to coordinate care with another provider (for example, your psychiatrist, primanry care physician, etc.) complete this form:
  • SFS Consent to Release Information Form

SFS Consent to Release Information - Word

SFS Consent to Release Information - PDF


SFS Court Services Letter of Agreement - Word
SFS Court Services Letter of Agreement - PDF

Note: To download Adobe Acrobat Reader for free, click here