Forms

Patients may be referred to Synergy Counseling Center by a friend, physician, specialist, hospital, pastor, institution, etc. Please complete a Referral Form by clicking below.

All new patients must complete an online Intake Form by clicking below.

Each of the following buttons connect you to the online form. Click ...

Or, you may download Paper Forms:

• Paper Intake Form
• Mood Assessment (Quick Test)
• Financial Assistance Application Form (if needed)
• Symptom Measures

Couples may be asked to complete one of the following.

• Pre-Marriage Assessment
• Marriage Assessment

Any of our assessments can be taken online. Email us at [email protected] and request online assessments.

If you would like for us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete the form below to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

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