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Counseling Services

Individual
Couples & Family
Relationship Issues
Grief and Loss
Anxiety and Fears
Depression
Personal Growth
Parenting Support
Stress Management
African American Mother with Daughter
African American Boy

Forms

 
 

If you're a first-time client the easiest option is to pick out the intake packet appropriate below and print it out on your computer and fill it out. Bring the filled out for to your first appointment. You can ask your therapist on the phone or email which packet is right for you. To open the packet you just need to click on the right form. eg. adult biograpical is for an adult, child if for children below 12 etc.

If you do not have a printer please plan on coming into the office an hour early to fill out paperwork or stop at the office and pick up the forms in the waiting room before your appointment or email us and we can send an intake packet to you as an attachment.

For all psychological assessments or forms for insurance, LTD, Workman's Comp, FMLA,, medical records, MRFCA, Bariatric Assessment form, or other types of evaluations the appropriate form below is listed but other testing materials may be required at the time of you appointments.

Also: If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form. To read our policies and procedures you may download our manual and read it below. Coordination of care forms for your doctor are in intake packets.

Consent to Release Information

serfiles/107730/file/Adult Biographical Packet(1).pdf

               
userfiles/107730/file/CHILD INFORMATIN INTAKE(1).pdf

               
userfiles/107730/file/Adult SA Eval(1).tif

               
userfiles/107730/file/teen packet[(1).pdf

               
userfiles/107730/file/COUPLES INFORMATION(1).pdf

 Consent for release

Biographical Packet new client

Children's Packet new client

Substance Abuse Adult - New Client

Teen information packet - New Client

Couples Information Packet - New Clients for two

Inner Access Therapy Policies and Procedures for SA Services



 
Policies and procedures

Note: To download Adobe Acrobat Reader for free, click here.

To schedule an appointment by phone, call 616-527-2619 or fill out the form below:

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE