There are several standard clinical intake forms that we ask each new client to complete:
Contact Information Form. This form provides us with your contact information and allows you to
specify how you would like to be contacted in the future by Cobb & Associates.
Informed Consent and Authorization for Services Form. This form summarizes important
information about confidentiality, fees, cancellation policies, and other practices and policies of Cobb &
Associates. Please review it, initial where necessary, and sign page 4.
Intake questionnaire. The purpose of this questionnaire is to aid
assessment and treatment planning by giving your therapist a broad overview of your
background and current situation at a glance. All information you
provide in this form will be kept as part of your confidential file.
should take about 10 minutes to complete these forms. So that we can
spend your session time focusing on your concerns and not paperwork, we prefer to have you fill them out ahead of time, before the start of the
first session. If you are coming as a couple, each spouse should fill out the complete package listed above.
Clicking on a link below will open a PDF version
of these forms in a separate window. Then you can print the forms
directly to your printer, complete them at home, and bring them with you
to the first appointment.
Click on a Link Below to Download Intake Forms
Please select one of the three categories below that most pertains to your situation and click on the link in that box to open the intake forms.
General Intake Package - New Client Forms
Use these forms if you are coming for individual counselling or couples counselling, including pre-marital counselling.
Use these forms instead of the General Intake Package if you are coming specifically for a Marriage Checkup (the Informed Consent and Authorization for Services Form includes additional information, and the Intake Questionnaire is a shorter, single-page version instead of the longer two-page version used in the General Intake Package).
Child and Family Intake Package - New Client Forms
Use these forms instead of the General Intake Package, if the counselling is for a child or youth under the age of 18, or if you are seeking family therapy and plan to have children or youth present in the sessions (there are
additional forms to complete for child or family therapy).
Watch Our Brief Step-Parenting Segments on Global Morning News
These brief 3-minute videos featuring Diane Gibson, of Cobb & Associates Inc. aired on Monday March 17, 2014 and Monday September 22, 2014 on Global Morning News. Click below to see what Diane has to say on the topic of step-parenting and bonding with a step-child.