Sandra H. Ritter, PhD, LPC
Sandra H. Ritter, PhD, LPC
Personal and family counseling
Personal and family counseling
. . . helping clients access hidden internal resources.
Forms you may need
All new clients should read the Client Services Agreement and the Notice of Privacy Practices. New clients are asked to print out (or follow the link for the electronic version where available) the appropriate documents in the "Intake Forms" section below, complete them, and bring them to the first session or email/fax them to us. In order to conserve paper, only the signature pages of the Client Services Agreement and the Notice of Privacy Practices need to be printed. The signature pages are coded with a revision date that allows us to track which version of the document you signed.
Client Service Agreement - Full Document - click HERE
Notice of Privacy - Full Document - click HERE
Intake Forms
Select documents below based on client type.
(Click HERE for a printable version of the Adult Intake form with just the signature pages of the Service Agreement (SA) and Notice of Privacy (NP) forms - To view the full documents, please click HERE (SA) and HERE (NP) or scroll up.)
(Click HERE for a printable version of the Child/Youth Intake form with just the signature pages of the Service Agreement (SA) and Notice of Privacy (NP) forms - To view the full documents, please click HERE (SA) and HERE (NP) or scroll up.)
Couple
Electronic: Partner 1: https://form.jotform.com/72113818484155
Partner 2: https://form.jotform.com/72366611584157
Please note: Partner One is the primary insurance holder and the name for which the appointment will be scheduled.
(Click HERE for a printable version of the Couples Questionnaire that must be completed by EACH person. AND HERE for the adult intake to be competed by the person in whose name insurance is to be filed . . . with just the signature pages of the Service Agreement (SA) and Notice of Privacy (NP) forms - To view the full documents, please click HERE (SA) and HERE (NP) or scroll up.)