Mindock Counseling and Wellness

Mindock Counseling and Wellness Mindock Counseling and Wellness Mindock Counseling and Wellness

309.696.4697

  • Home
  • Anxiety Assessment
  • Reviews
  • Learning
  • About
    • Meet Sharon
    • Philosophy
  • Services
    • Anxiety
    • Counseling
    • Coaching
    • Holistic Services
    • NET
    • Reiki
    • Emotional Freedom Tech
  • Blog
  • Investment
  • Forms
  • Contact
  • More
    • Home
    • Anxiety Assessment
    • Reviews
    • Learning
    • About
      • Meet Sharon
      • Philosophy
    • Services
      • Anxiety
      • Counseling
      • Coaching
      • Holistic Services
      • NET
      • Reiki
      • Emotional Freedom Tech
    • Blog
    • Investment
    • Forms
    • Contact

Mindock Counseling and Wellness

Mindock Counseling and Wellness Mindock Counseling and Wellness Mindock Counseling and Wellness

309.696.4697

  • Home
  • Anxiety Assessment
  • Reviews
  • Learning
  • About
    • Meet Sharon
    • Philosophy
  • Services
    • Anxiety
    • Counseling
    • Coaching
    • Holistic Services
    • NET
    • Reiki
    • Emotional Freedom Tech
  • Blog
  • Investment
  • Forms
  • Contact

MINDOCK COUNSELING & WELLNESS FORMS

Mindock Counseling and Wellness Peoria IL Anxiety Counselor and Coach.  Yoga image

FORMS

Please print and complete each of these forms before your first appointment.  Bring the completed forms to your first visit with me.  This information will help me to get to know you better and provide the required insurance paperwork needed for reimbursement.  


I accept most major insurance plans, credit cards, check and cash.  Payment is due at the time of your appointment.

Client Intake Form (pdf)

Download

Informed Consent Form (pdf)

Download

Notice of Privacy Practices (HIPAA) Form (pdf)

Download

Notice of Privacy Practices Receipt (pdf)

Download

Anxiety screening (pdf)

Download

Depression screening (pdf)

Download

Drug Abuse Quiz (pdf)

Download

Connect With me

ADA Accessibility

READY FOR CHANGE? LET'S TALK

CONTACT ME

Copyright © 2020 Mindock Counseling - All Rights Reserved.

Design by Seeforth Website & Graphic Design

  • Anxiety Assessment
  • Reviews
  • Learning
  • Meet Sharon
  • Philosophy
  • Anxiety
  • Counseling
  • Coaching
  • Holistic Services
  • NET
  • Reiki
  • Emotional Freedom Tech
  • Blog
  • Investment
  • Forms
  • Contact