Forms

The forms can be downloaded and completed electronically. Once completed, save the forms to your phone or computer and attach your completed forms to samaritancenter@sbcglobal.net

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Please submit the forms at least 24 hours prior to your scheduled appointment. If you have any questions or are unable to complete the forms electronically, contact the office before your scheduled appointment at 219-923-8110.

 

Confidential Client Questionnaire 

Telehealth Consent Form

Burns Depression Inventory

Burns Anxiety Inventory