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

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Youth Checklist

Complete Youth Checklist  for youth ages 16 and younger

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


Steps for Completing Youth Checklist

Please choose the appropriate link below to complete Youth Checklist  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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