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):
Choose the following based on who your counselor is:
Joan B. Clare LCSW
Notice of the Privacy Practices of the Samaritan Counseling CenterAnthony Dillon MA CADC
Notice of the Privacy Practices of the Samaritan Counseling CenterDr. J. Mark Kilmer LMFT
Notice of the Privacy Practices of the Samaritan Counseling CenterMarion Larson-Belcher LMHC
Notice of the Privacy Practices of the Samaritan Counseling CenterBunny Schlotman MSN
Notice of the Privacy Practices of the Samaritan Counseling CenterRoy Thomas LCSW
Notice of the Privacy Practices of the Samaritan Counseling CenterDebi DallaCosta, LCPC, LMHP
Notice of the Privacy Practices of the Samaritan Counseling Center
Kathryn Jones
Notice of the Privacy Practices of the Samaritan Counseling CenterCyndi Anderson
Notice of the Privacy Practices of the Samaritan Counseling Center