Molly Richter, LMFT, LLC
Molly Richter, LMFT, LLC

Client Forms

 

New clients will need to fill out some forms before therapy can begin. To make our process as smooth and efficient as possible, you can download the documents here, print and fill them out at home, and bring them into your first session.

 

All forms are also available at the office; if you can't fill them out in advance, let me know and I will provide you with the forms to fill out fifteen minutes prior to your first appointment time.

 

 

There are 4 forms to download, numbered 1-4. You only need to download one of the Client Information Forms (#1). Please download the version that best applies to you - individual (adult), minor, or couple/family.

If you're unsure which forms to fill out, please don't hesitate to contact me.

 

Form 1. Client Information Form - please select the version that applies to you

Client Information Form for Individuals
1. MSR LLC Client Info Form.pdf
Adobe Acrobat document [60.0 KB]
Client Information Form for Minors
1. MSR LLC Client Info Form - Minor.pdf
Adobe Acrobat document [65.4 KB]
Client Information Form for Couples or Families
1. MSR LLC Couple Info Form.pdf
Adobe Acrobat document [67.4 KB]

Form 2. Strengths and Symptoms - please download a copy for each person who will be participating.

Strengths and Symptoms
2. Strengths and Symptoms lists.pdf
Adobe Acrobat document [69.5 KB]

Forms 3 & 4. Download one of each.

Client Contract
3. MSR LLC Client Contract 2023.pdf
Adobe Acrobat document [2.4 MB]
Telehealth Consent Addendum
Please download and sign the Telehealth Consent in addition to the Client Contract.
Molly Richter LMFT LLC Telehealth Consen[...]
Adobe Acrobat document [2.3 MB]
Questions for your Insurance Provider
4. MSR LLC Insurance Questions.pdf
Adobe Acrobat document [2.3 MB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Print | Sitemap
All text and images copyright Molly Richter, LMFT, LLC