Menu
Sojourners
  • Home
  • About
    • Mission
    • What to Expect
    • Map & Directions
  • Therapists
    • Julia Armstrong LPC ATR-P
    • Lisa Davies LPCC-S NCC LICDC
    • Jason Eicher LPC
    • Nick Gotschall LPCC
    • Kyle Kershner LPCC-S NCC LICDC-CS
    • Jillian Ponchot LPC
    • Angela Stanley LPCC-S
    • Laura Statler LPCC
    • Michelle Updegraff LPCC NCC
  • Contact
  • Resources
    • Intake Forms
    • Telehealth
    • Knox County and Local Resources
    • Recommended Resources
  • Home
  • About
    • Mission
    • What to Expect
    • Map & Directions
  • Therapists
    • Julia Armstrong LPC ATR-P
    • Lisa Davies LPCC-S NCC LICDC
    • Jason Eicher LPC
    • Nick Gotschall LPCC
    • Kyle Kershner LPCC-S NCC LICDC-CS
    • Jillian Ponchot LPC
    • Angela Stanley LPCC-S
    • Laura Statler LPCC
    • Michelle Updegraff LPCC NCC
  • Contact
  • Resources
    • Intake Forms
    • Telehealth
    • Knox County and Local Resources
    • Recommended Resources

Intake Forms

Our intake forms are provided here for you to fill out and bring to your first appointment along with a photo ID and insurance card.
Click on the link to download the Word document to your computer.
 


​Adult Forms 

Includes the following forms:
- Fact Sheet
- Client History
- Consent to Use and Disclose Your Health Information
- Privacy Practices
- Financial Policy



​Minor Forms

Includes the following forms:
- Fact Sheet
- Client History
- Consent to Use and Disclose Your Health Information
- Privacy Practices
- Financial Policy

Sojourners Counseling Services, LLC
​111 South Mulberry St. Mount Vernon, OH | 740-393-6001 | office@sojournerscounseling.com
Powered by Create your own unique website with customizable templates.