If you have not contacted Samaritan Counseling Services to receive a referral, please call our office at (941) 926-2959 so that we can match you up with the counselor that best fits your needs.

Rick Howell, Th.M, LMHC​
David Aviles, RMHCI
Christie Byrne, LMHC
​Melissa Carlson, LCSW
Loary Coates, MA, PMHC
Benoit Duhamel, M. Div., MS, RMFTI
Griselle Feisthammel, MA, LMHC
Elizabeth Ibanez, Ph.D
​​Laura Johnston, LCSW

Bill Martin, LMHC
Linda Martin, MS, LMHC
Maribeth McDermott, LMHC
Lin A. Mertens, LCSW
​James Miller, MSW, LCSW
Leah Petrucci, MA,RMHC
Donald Ross Thompson, LMHC
Kelly Tse, MSW, RCSWI
Conni Valenti, MSW, RCSWI
Richard Vantrease, D. Min., LMFT

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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. Privacy Policy/Disclosure Statement Signature Form
4. Financial Agreement Form

Form Names
Privacy Policy

Therapist Disclosure Statement (see below)
Privacy Policy/Disclosure Statement Signature form
Financial Agreement

Informed Consent Forms
Daniel Aviles
Christie Byrne
Melissa Carlson
​Loary Viola Coates
​Natalie Dennison
Benoit Duhamel
​Griselle Feisthammel
Rick Howell
​Dr. Elizabeth Ibanez
Laura Johnston
Linda Martin
Lin A. Mertens
Maribeth McDermott
James Miller
Leah Petrucci
Sandy Pulos
Donald Ross Thompson
Connie Valenti
Richard J. Vantrease

Print, complete and bring forms along to your first appointment.

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