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Deer Valley Counseling

Compassionate, Caring Counseling

Offices in Phoenix, Mesa and Scottsdale

 

Forms

Here are some useful forms. You will need the Adobe Reader to view these files. Get Acrobat Reader Web logo

Adult Intake Packets

If you like, you can download, print, fill out, and bring an intake packet with you to your first session to save time. If more than one adult is attending, each must fill out their own packet. If you are attending just to support the other person, not for treatment for yourself, fill out your packet (including the treatment plan) from the point of view that you are there to help the other person.

Child Intake Packet

If you have made an appointment for your child (under age 18), you can download, print, fill out, and bring these forms with you to your child's first session to save time. You must come with your child the first time. If you are going to come in to see the counselor with your child, you must fill out an adult intake packet (including the treatment plan) from the point of view that you are there to help your child.

Authorization for Release of Confidential Information

If you would like for Deer Valley Counseling to release confidential information about you or your child to someone else, you must authorize us to do so in writing using this form—Authorization for Release of Confidential Information. Download the form, print it out, fill it out, and then fax it to Deer Valley Counseling. You will have to call Sandra Nettles at 602.750.8051 for the fax number since we do not put that number on the internet. More information about the Deer Valley Counseling privacy policy can be found at Privacy.

Request for Copies

If you would like for Deer Valley Counseling to send you a copy of your file, you must request us to do so in writing using this form—Request for Copies. Download the form, print it out, fill it out, and then fax it to Deer Valley Counseling. You will have to call Sandra Nettles at 602.750.8051 for the fax number since we do not put that number on the internet. Please note that if more than one person was present at a session, then we will have to receive an Authorization for Release of Confidential Information from each of the other persons present at the session before we can release the information for that session.

Privacy Policy

Deer Valley Counseling respects your privacy. You can read about our privacy policies in Deer Valley Counseling Notice of Privacy Practices.

Clinicians Notice

Important information about the Deer Valley Counseling clinicians can be found in the Clinicians Notice.

Additional Form for New Mexico Clients

For clients who are located in New Mexico at the time services are provided, we must also give you our Professional Disclosure Statement.

 

 

The material on this web site is for informational purposes. More detailed information can be found by contacting the National Institute of Mental Health. A diagnosis can only be made by a qualified professional.

Serving Phoenix, Scottsdale, Mesa, Chandler, Gilbert, Glendale, Peoria, Tempe, Ahwatukee and nearby cities. Offices at —

2301 W Dunlap Ave, Suite 206, Phoenix AZ 85021
1819 S Dobson Rd, Suite 105, Mesa AZ 85202
14274 N Northsight Blvd, Suite 100, Scottsdale AZ 85260