CCM Counseling Services | Charlotte, NC

Therapist specializing in | Anxiety | Depression | Recovery | Addiction

Home New Patient Forms

New Patient Forms

Please download, print, fill out, and sign each of the requested forms below and bring them with you to your first appointment.


Client Information

Please complete this form by answering the questions as honestly and completely as possible so that I might know how to best support you on your journey.


Consent for Treatment

The decision to utilize counseling, or psychotherapy, or other related services is an important one to get you on your journey to see positive results.


HIPAA Notice of Privacy

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.


Clients Rights & Confidentiality

What you say in your therapy session is confidential, which means that it is private and cannot be shared with anyone outside of this office without your written permission.


Treatment & Billing Agreement

This notice helps foster a transparent and trusting relationship between provider and patient, promoting better healthcare outcomes and patient satisfaction. Please review this notice carefully.