Home
Available Programs
Newsletter
Thoughtful Topics
Directions
Personnel
Covenant Congregations
Forms for Download
Donations

Download Forms

These are forms to be printed, filled out and brought with you to your first session (you may open and print them from your browser, or right-click and choose "Save Link As..." to download and print them out later):

Confidential Client Questionnaire (C8)

Choose the following based on who your counselor is:

Joan B. Clare LCSW
Notice of the Privacy Practices of the Samaritan Counseling Center

Anthony Dillon MA CADC
Notice of the Privacy Practices of the Samaritan Counseling Center

Dr. J. Mark Killmer LMFT
Notice of the Privacy Practices of the Samaritan Counseling Center

Bunny Schlotman MSN
Notice of the Privacy Practices of the Samaritan Counseling Center

Debi DallaCosta, LCPC, LMHP
Notice of the Privacy Practices of the Samaritan Counseling Center

Melinda McKeague, MBA, MA, LMHC, LCPC
Notice of the Privacy Practices of the Samaritan Counseling Center