12995 Sheridan Blvd., Suite 104
Broomfield, Colorado 80020

Phone: 303-410-0224 | Fax: 720-566-9734
email: caftherapy@qwestoffice.net

 

Gaye Lynn Schankweiler, MA, LPC.

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forms

Forms

For your convenience, please download, print, and complete the following documents prior to your arrival. Then bring them with you on the first appointment. This will allow us to maximize our time together.

 

Since these documents contain personal identifiable information please DO NOT e-mail them to the office.

  1. Patient Registration
  2. Consumer Client-Rights and Consent to Treat
  3. Limits of Confidentiality
  4. Notice or Privacy Rights
  5. Disclosure Statement
  6. Biographical Information (for children age 2-18)
  7. Client Intake and Information (for adult over age 18)

 

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