New Client Forms

Thank you for choosing Charlotte Therapy Associates for your behavioral health care services. We recognize there are many choices and appreciate your trust in us. We appreciate if you would download and completing the necessary paperwork prior to your first session. Completing this paperwork allows us the opportunity to spend more time on clinical rather then admistrative issues. We will be happy to address any questions or concerns regarding paperwork in your first session. Please remeber to bring your insurance card as well. We look forward to working with you soon.

Forms for Clients of Ashleigh Bryan, MS, LMFT


Adult Client Forms:

Therapy Agreement


Minor Client Forms:

Therapy Agreement for Minor

Minor Client Information Sheet

HIPPA

Medication and Physician Form

Consent for Treatment

Forms for Clients of Kate van Wagenberg, MS, LMFT

Adult Client Form


Client Forms for Diane Yee, MS, LPC

Therapy Agreement

Client Information Sheet

Medication and Physician Summary Form

Consent for Treatment

HIPPA


Rose Richardson, MA, LMFT

Client Information Sheet

HIPPA

Therapy Agreement





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Contact Us Today

Charlotte Therapy Associates, PLLC

5200 Park Rd, Ste 219, Charlote, NC

Office Hours

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-5:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-5:00 pm

Saturday:

Closed

Sunday:

Closed