Forms for Counseling Services

APPLY FOR SERVICES

If you wish to apply for services and have not yet scheduled an appointment, please call us at (619) 713-1544 to leave a confidential message. Our Lead Therapist will call back to take your application information over the phone and answer any questions you may have.

You may prefer to download and fill out the Application for Services Form and submit by email to:  newdaywomenscenter@gmail.com. Our Lead Therapist will contact you to follow up and answer any questions you may have.

To be eligible for sliding scale discounts or scholarships for services, you will also need to download and submit the Scholarship Application Form along with supporting documents described on the form.

NEW CLIENTS (CURRENTLY SCHEDULED FOR AN APPOINTMENT):

Whenever we receive a new client, we are required to process Intake Paperwork which provides us with your information in addition to consent for counseling. You can click on the Client Intake Form, Financial Agreement, and Informed Consent to print out and complete prior to your session, or you can choose to arrive 15 minutes early and we will have them ready for you to fill out.

If the client is a child or youth, both parents are required to sign the Consent to Treat a Minor form before counseling (unless you are a parent with 100% legal custody).

The Notice of Privacy Practices informs you of our policy in regards to your personal information. This is for you to print out and keep for your records.

If you wish to apply for sliding scale discount or scholarships for services, you will also need to download and submit the Scholarship Application Form along with supporting documents described on the form.

COUNSELING INTAKE FORMS FOR SCHEDULED NEW CLIENTS:

Client Intake Form

Financial Agreement Form

Informed Consent Form

Notice of Privacy Practices

Consent to Treat a Minor

Scholarship Application Form