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    5800 49th St N Suite 102
    St. Petersburg, Florida 33709
    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

    5800 49th St N Suite 102
    St. Petersburg, Florida 33709

    352-507-8075
    ericschleichlcsw@gmail.com


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    Hope and Healing of Pinellas
    ericschleichlcsw@gmail.com | 352-507-8075
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