C. Blair Skinner, LMFT
Specializing in Early Childhood & Play Therapy

Helpful Forms

If you're a new client, please complete the following forms and bring them to your first session.

  • Disclosure Statement
  • Client Information Intake Form
  • Fee Agreement
  • Consent for Treatment of a Minor
Please review the following information which we can discuss further at your first appointment.
  • Privacy Rights

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form:

  • Consent to Release Information Form

userfiles/224870/file/Disclosure Statement 2_12.pdf Disclosure Statement
userfiles/224870/file/Privacy Rights 2011.pdf Privacy Rights
userfiles/224870/file/Client information 2011.pdf Client Information Intake Form
userfiles/224870/file/Fee Agree 2011.pdf Fee Agreement
userfiles/224870/file/Consent for Minor 2011.pdf Consent for Treatment of a Minor
userfiles/224870/file/Release of Information 2011(1).pdf Release of Information
userfiles/224870/file/Medical Records 2011.pdf Medical Records Policy

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