The following forms are required for your first visit to the Samaritan Counseling Center.  

Please print a copy of each one and bring the completed and signed copies with you to your first appointment, otherwise you will be required to arrive 15 minutes before your scheduled appointment so you can fill these forms out prior to your initial session with the counselor.

In order for us to comply with Federal Trade Commission guidelines, please bring a government issued Photo ID or Utility Bill showing current address and your Health Insurance Card to your first appointment. 

Patient Information Form (PIF)

Agreement for Therapy

Privacy Policy