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1390 Oak St. #1
Eugene, OR 97401
541.349.0595

Counseling Intake Forms

You can print and fill out these forms prior to our meeting if you'd like, or I will supply copies when we meet.

1) Professional Disclosure

2) Informed Consent

3) Permission to Treat

4) Client Information

5) Financial Agreement

6) Credit Card Authorization

If you are unable to open the pdf document please download the Adobe Reader.

Download Past Newsletters from Ker Cleary:

Doorknob Gazette Winter 2007.pdf

Doorknob Gazette Fall 2007.pdf

Doorknob Gazette Summer 2007.pdf

Doorknob Gazette Spring 2007.pdf

Doorknob Gazette Winter 2006.pdf

Doorknob Gazette Fall 2006.pdf

 


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© 2006 Ker Cleary, M.A
E-mail: Ker Cleary Phone: 541.349.0595