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Client Forms

Make an appointment

You can conveniently make an initial appointment by:

  • completing this form with your information
  • calling us at 330-972-6822

Initial paperwork

Prior to your first appointment, all clients are required to complete initial paperwork.

HIPAA

Notice of privacy practices at the Clinic for Individual and Family Counseling. Effective now this notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.