• Counseling or Assessment and Evaluation Forms
• Groups and Classes

Children and Adolescents
Please complete the following forms:

1. Client Registration Form
2. Informed Consent Form
3. Notice of Privacy Practices Form
4. Financial Policy Form
5. Release of Information Form
   Please complete a separate Authorization to Release/Obtain Information form for each provider (e.g., pediatrician, teacher, past therapist) that you wish Legacy to gain information from and/or release information to.
6. Legacy Disclosure Form
7. Co-Parent Form: If your child or adolescents resides in more than one home or has visitation with a non-custodial parent please complete this form. Children receiving services from Legacy will need to have both parents consent for counseling if the child’s parents are separated or divorced.

Family and Couples
Please complete the following forms:

1. Client Registration Form
2. Informed Consent Form
3. Notice of Privacy Practices Form
4. Financial Policy Form
5. Release of Information Form
   Please complete a separate Authorization to Release/Obtain Information form for each provider (e.g., pediatrician, teacher, past therapist) that you wish Legacy to gain information from and/or release information to.
6. Legacy Disclosure Form

Adults

1. Client Registration Form
2. Informed Consent Form
3. Notice of Privacy Practices Form
4. Financial Policy Form
5. Release of Information Form
   Please complete a separate Authorization to Release/Obtain Information form for each provider (e.g., pediatrician, teacher, past therapist) that you wish Legacy to gain information from and/or release information to.
6. Legacy Disclosure Form