Client Paperwork

Welcome to Stein Counseling & Consulting!

We look forward to working with you. Before we get started, please read and fill out the forms below. Once you complete them, they will be electronically forwarded to us and no paper copies will be needed.

If you need assistance, or have any questions please feel free to contact us by email or phone.

New Client Intake Paperwork

In addition to the New Client Intake paperwork, please complete the DSM-5 Checklist(s) that correspond to the client being seen. This documents helps your provider better understand any symptoms the client may be experiencing. If the client is an adolescent (ages 11-17), they will complete the Adolescent Checklist, and we also ask that a parent/guardian completes the Parent/Guardian Checklist.

  • DSM-5 Symptpom Checklist – Adult
  • DSM-5 Symptpom Checklist – Adolescent
  • DSM-5 Symptpom Checklist – Parent/Guardian

    Due to HIPPA regulations, a Release of Information is needed for any individual you would like us to be able to communicate with. This is commonly a spouse/family member, health care provider, or court official.

  • Release of Information

    If you are receiving Telehealth (video or phone) session please complete the following form.

  • Consent for Telehealth

  • Make an appointment Information Request Form