Client Forms

Most forms are in PDF format; you will need the current version of Adobe Reader in order to read the forms. If you don't already have Adobe on your computer it's available as a quick, free software download.  

Complete the Forms

Download and save the following required forms to your computer.
Both new and returning clients must complete and return all printed and signed forms.

1) The Privacy Policy (signed)
2) One signed copy of your therapist's Disclosure Statement
3) The Client Information form (2 pages)
4) Spanish version of Privacy Policy and Disclosure Statement are included with Spanish version of Client Information Form

Form Names
Client Information Form (English)    
Client Information Form (Spanish)
Privacy Policy
Client Satisfaction Survey

Disclosure Statements
Rick Howell, Th.M., LMHC
Diane Brantley, LCSW   
Dr. Dennise Lawry, Psy. D.
Melissa Miller, LCSW  
David Preston, LCSW

If possible, mail to or drop off the completed and signed forms* at the Bee Ridge office,
in advance of your first session so your therapist has time to review them. The address is:

ATT: (insert your therapist's name)
Samaritan Counseling Services of the Gulf Coast
3224 Bee Ridge Road
Sarasota, FL  34239

*Please keep copies of the Privacy Policy and the Disclosure Statement for your records.