New Client Paperwork

Please print, read through, and fill out the appropriate forms and bring them with you to your first therapy appointment.

Child Assessment
Child Intake Questionnaire
Child Therapy Services Agreement
Adult Service Agreement
Adult Intake Questionnaire
HIPAA Form
Release of Information Form
Credit Card Payment Form

Payment Information

Studio For Change® accepts out-of-pocket payments and payments made by Blue Cross/Blue Shield (BC/BS PPO). For other insurance carriers, clients are provided a receipt with necessary information needed to submit for fee reimbursement. Studio For Change® offers the complimentary service of checking benefit information for our prospective clients. Please note that benefit information is subject to change and should also be verified by the client.

Insurance Benefit Verification