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Client Forms in PDF Format

7 Steps to Sanity


Intake & Discharge Forms

  • Garden teaches you an easy and effective system of Cognitive Behavioral Therapy (CBT).

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TERMS OF USAGE

You are allowed to print, copy, and make use of the PDF documents linked to this page as long as you fully comply with three stipulations: (1) you are a current client of Kevin Everett FitzMaurice, M.S.; (2) you agree to make no changes of any kind to these documents; (3) you make sure the copyright notice remains intact on each and every document that you use. These protections are for the integrity and right use of the documents. Thank you for your compliance and cooperation in following all three of these requirements. If you wish to make use of these forms for your counseling practice or counseling agency or for any other reason, then you must purchase the right to use them from the author of the forms as stated in the copyright notice. Thank you.


INTAKE FORMS

  1. 12 Limits to Confidentiality
  2. Behavioral Problems Checklist
  3. Beliefs Regarding Change
  4. Bill Tracking
  5. Brochure: Client’s Responsibilities
  6. Brochure: Client’s Rights
  7. Cancel and No-Show
  8. Cancellation Policy
  9. Change of Status
  10. Confidentiality: Limits of
  11. Consent for Services
  12. Discharge Summary
  13. Emotional Problems Checklist
  14. Financial Information
  15. Follow-up Contact
  16. Forms Checklist
  17. Forms Explain
  18. Forms Explain #2
  19. HIPPA Privacy Notice
  20. HIPPA Privacy Notice: Please Sign
  21. Incident Report
  22. Insurance Complaint Form
  23. Insurance Questions
  24. Medication List: Initial
  25. Medication List: Ongoing
  26. No Self-Harm Contract
  27. Orientation for EC and REBT
  28. Orientation for Counseling with Kevin: Front
  29. Orientation for Counseling with Kevin: Back
  30. Policy Record Copying
  31. Primary Data
  32. Progress Note
  33. Release of Information: Generic
  34. Release of Information: Insurance
  35. Release of Information: Medical
  36. Social History
  37. Staffing with Dr. Topf
  38. Technique Checklist
  39. Treatment Plan
  40. Treatment Plan Helper

DISCHARGE FORMS

  1. Discharge Session
  2. 3 As of Relapse Prevention

Quotations from Various Sources

Organized Alphabetically.

“A fool is only a fool because he won’t see he is a fool.” —Kevin Everett FitzMaurice

“A man of genius makes no mistakes. His errors are volitional and are the portals of discovery.” —James Joyce

“But if ye be without chastisement, whereof all are partakers, then are ye bastards, and not sons.” —Hebrews 12:8

“By honestly acknowledging your past errors, but never damning yourself for them, you can learn to use your past for your own future benefit.” —Albert Ellis and Robert A. Harper, A Guide to Rational Living, Third Edition, p. 194

“Correction is grievous unto him that forsaketh the way: and he that hateth reproof shall die.” —Proverbs 15:5

“Failure doesn’t have anything to do with your intrinsic value as a person.” —Albert Ellis and Robert A. Harper, A Guide to Rational Living, Third Edition, p. 206

“For whom the Lord loveth he chasteneth, and scourgeth every son whom he receiveth.” —Hebrews 12:6

“If we eliminated all errors, we would also eliminate much discovery, art, insight, learning, and creativity that results from facing errors.” —Kevin Everett FitzMaurice

“If ye endure chastening, God dealeth with you as with sons; for what son is he whom the father chasteneth not?” —Hebrews 12:7

“My son, despise not the chastening of the LORD; neither be weary of his correction:” —Proverbs 3:11

“The greatest explorer on this earth never takes voyages as long as those of the man who descends to the depth of his heart.” —Julien Green

“The trouble with most of us is that we would rather be ruined by praise than saved by criticism.” —Norman Vincent Peale

“When receiving correction, the wise seeks to learn and the fool seeks to justify with excuses.” —Kevin Everett FitzMaurice


Quotations from Scripture

“A wise man will hear, and will increase learning; and a man of understanding shall attain unto wise counsels:” —Proverbs 1:5 

“Where no counsel is, the people fall: but in the multitude of counselors there is safety.” —Proverbs 11:14 

“The way of a fool is right in his own eyes: but he that hearkeneth unto counsel is wise.” —Proverbs 12:15 

“Deceit is in the heart of them that imagine evil: but to the counselors of peace is joy.” —Proverbs 12:20 

“Without counsel purposes are disappointed: but in the multitude of counselors they are established.” —Proverbs 15:22 

“Hear counsel, and receive instruction, that thou mayest be wise in thy latter end.” —Proverbs 19:20 

“Every purpose is established by counsel: and with good advice make war.” —Proverbs 20:18 

“Take counsel, execute judgment; make thy shadow as the night in the midst of the noonday; hide the outcasts; bewray not him that wandereth.” —Isaiah 16:3 

“Extol not thyself in the counsel of thine own heart; that thy soul be not torn in pieces as a bull [straying alone.]” —Ecclesiasticus 6:2 

“As timber girt and bound together in a building cannot be loosed with shaking: so the heart that is stablished by advised counsel shall fear at no time.” —Ecclesiasticus 22:16 

“Give not over thy mind to heaviness, and afflict not thyself in thine own counsel.” —Ecclesiasticus 30:21 

“A man of counsel will be considerate; but a strange and proud man is not daunted with fear, even when of himself he hath done without counsel.” —Ecclesiasticus 32:18 

“And let the counsel of thine own heart stand: for there is no man more faithful unto thee than it.” —Ecclesiasticus 37:13 

“Let reason go before every enterprize, and counsel before every action.” —Ecclesiasticus 38:33 

“Gold and silver make the foot stand sure: but counsel is esteemed above them both.” —Ecclesiasticus 40:25

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