Forms for Counseling Services

APPLYING 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 including your name and a number that we may reach you at. Our lead therapist will then call you as soon as she can to take your application information over the phone and give you answers to any questions you may have.

If you do not wish to call, 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 give you answers any questions you may have soon after you submit the form.

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 Packet 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 which is attached in the Client Intake Packet for Minors before the first counseling session (unless you are a parent with 100% legal custody).

The Notice of Patient Information Practices, Acknowledgment of Licensure Status, and the Informed Consent forms inform you of our policies in regards to your personal information. The Notice of Patient Information Practices form is for you to keep for your records. The other two are there for you to print out and fill out before your first appointment (they are also apart of the Client Intake Packet).

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.

There might be some other forms that you need fill out as well; these include the Informed Consent for In-Person Services During Covid, the Telehealth Consent, and the Consent for Audio/Video. These forms are used for many different reasons in many different instances. If for any reason your therapist requests that you sign these forms, they are attached here for your convenience.

COUNSELING FORM LINKS FOR SCHEDULED NEW CLIENTS:

Client Intake Packet for Adults

Client Intake Packet for Minors

Consent to Treat a Minor

Notice of Patient Information Practices

Acknowledgment of Licensure Status

Informed Consent

Scholarship Application Form

Consent for In-Person Services During Covid

Telehealth Consent

Consent for Audio/Video