Client Forms

Intake Form

New clients, complete the intake form & bring it to your first therapy session.




Helpful Forms

Release of Information Form

Life History Form

Your Information Your Rights Our Responsibilities




Current Client Survey - How are we doing?

Previous Client Survey - How'd we do?




Authorization to Disclose Information

If you would like us to coordinate care with another provider (For example, your psychiatrist, primary care physician, etc.) complete this form and authorize release of psychotherapy information .

Authorization to Disclose Information Form


Contact Us
 Spring Lake Office

17224 VanWagoner Rd
Spring Lake MI 49456

Google Maps →



 Jenison Office


1388 Baldwin St. Suite A
Jenison MI 49428

Google Maps →

Grand Rapids Office
1465 3 Mile Rd NW
Grand Rapids MI 49544

(In Orchard Hill Church)




Fremont Office

4040 West 72nd Or M-82
Fremont MI 49412

(In Midwest Psychology Building)

Google Maps →




Emergency #





Fax #





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