If you are at a crossroads in your life, and are searching for new direction, please contact Two Roads Family Therapy by phone or email to schedule an individual, couple, or family therapy consultation.
Forms
All new clients need to complete the Personal Information Form and the Adult Checklist of Concerns. Additionally, if a child is participating in therapy, the Child Checklist of Concerns must also be filled out. The completed forms can be presented at the time of the intake session. If you do not have access to a printer, the forms will be provided to you when you arrive.
Personal Information
This form provides our office with general contact information, and information regarding responsibility of payment, whether through state insurance or private pay.
Child Checklist of Concerns
This form provides a list of potential concerns relating to a child, for the parent or guardian to review and indicate what problems or issues they would like to have addressed in the therapy process.
Adult Checklist of Concerns
This form provides a list of potential concerns for the client to review and indicate what problems or issues they would like to have addressed in the therapy process.
Notice of Privacy Practices
The Notice of Privacy Practices describes the confidentiality of your medical records, how the information is used, your rights, and how you may obtain this information. It is for your records only. You will be asked to sign a form at the intake session indicating that you were given access to a copy of the Privacy Practices Notice for Two Roads Family Therapy.