Forms

The following forms are required for all new clients in our office.

Account Information
ACCOUNT INFORMATION.pdf
Adobe Acrobat document [64.5 KB]
Adult Intake
Adult Intake Form-New client.pdf
Adobe Acrobat document [431.6 KB]
Child Intake
Child Intake.pdf
Adobe Acrobat document [312.9 KB]
Client Agreement and Therapeutic Policies
Client Agreement and Therapeutic Policie[...]
Adobe Acrobat document [145.7 KB]
Consent for Treatment of a Minor
CONSENT FOR TREATMENT OF A MINOR CHILD.p[...]
Adobe Acrobat document [366.2 KB]
Release of Private Health Information
Release of Private Health Information.pd[...]
Adobe Acrobat document [177.7 KB]

Contact Us

Address

Successful Therapy
526 W Center Street

Suite S-107

Pleasant Grove, UT

84062

 

Phone: 801 787 7735

 

Email:

successfultherapy@gmail.com

 

Or use our contact form.

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