Barbara Raymer Becherer, LPC, RPT-S, NCC, NBCCH, M.Ed.

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Client Intake Form

Client Information~Informed Consent ~ Financial Agreement

CLIENT INTAKE FORM

 COMPLETING CLIENT INTAKE FORM 

This web page is NOT HIPPA Compliant.   Barbara Becherer does not take responsibility for the security of your transmitting your forms. 

Please choose the appropriate link below to complete Client Intake Form.

If you have  Microsoft word software on your computer
use the Word link to open and complete this form on your computer.   

If you do not have Microsoft word please use the PDF link

Word document steps as follows:

1.   Click on the word document link below and form  will open

 2. Complete form on your computer
 
3.  Save the completed document to your computer
(make note of file name & location of  saved file)

4. Email completed form to  your counselor:

Baraymer@gmail.com 

        OR

5. Instead of emailing form you can print completed form and bring with you to your first appointment.

  
Word Document Link


PDF form follow the steps as follows:

1. Click on the PDF document link below and form will open

2. print form and complete in writing

3. Bring completed form with you to your first appointment


 
PDF Link 






 

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