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    710 94th Street N Suite 305
    Saint Petersburg FL 33702
    ericschleichlcsw@gmail.com | 352-507-8075

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    Client Forms

    If you are new to therapy, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy, and allow as much time as possible to be spent focusing on you.

    Adult Intake Form

    Adult Checklist of Concerns

    Child/Teen Intake Form

    Child Checklist of Concerns

    Information for Clients

    Notice of Privacy Practices

    Consent to Treatment

    Agreement to Pay for Professional Services

     


    Hope and Healing
    of Pinellas

    710 94th Street N Suite 305
    Saint Petersburg FL 33702

    352-507-8075
    ericschleichlcsw@gmail.com


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    ericschleichlcsw@gmail.com | 352-507-8075
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