Autonomy Counseling, PLLC

Intake Process

Intake paperwork is required for services. The preferred method of intake paperwork completion is the client portal that can be signed and filled out online securely before the first appointment. After we receive your request for your initial meeting, we will send you the paperwork. If you have been unable to complete the intake paperwork before the first appointment, the clinician will review the forms with you and have you sign.


If using insurance, in the first session, the clinician will conduct an assessment to assign a billing diagnosis. During the evaluation, the clinician will ask you many questions about what is currently happening in your life and developmental questions.


If you would like to preview the forms or fill them out before the session outside the client portal, click the buttons below to view and/or fill out the forms. Each case requires different intake paperwork. Please don't hesitate to contact us with any questions about what types are needed.


Sliding Fee: Form #9 is our sliding fee scale application. Autonomy Counseling, PLLC offers a sliding fee eligible to clients. The rates for services are adjusted based on the client's ability to pay. The application is based on federal poverty guidelines and family size and income only.


     Forms‚Äč

1. Informed Consent

2. Electronic Communication Agreement

3. Financial Responsibility

4. Telehealth Consent

5. Standard Intake Questionnaire

6. GAD7 Assessment

7. PHQ9 Assessment

8. Release of Information

9. Sliding Fee Application

10. Co-Parenting Consent

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