Intake Paperwork for Couples

Be sure to speak with Cindy or Kathleen concerning fit and availability before filling out and submitting your paperwork.

Please download and print two copies of the following forms. Please make sure each of you fill out your own Confidential Personal Record and review and sign the Couples Therapy Agreement. Bring all copies with you to your first session. Thank you.

After you complete the paperwork, please send files to Cindy at or Kathleen at

If you have any questions, please call our office at 315-436-5428.

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