Forms
Prior to your first visit, there are several forms you can complete and bring with you. These forms are required to be completed before you can be seen as a client in the clinic. The forms both provide quality information to your counselor and cover some of the more legal aspects of our clinic to meet HIPPA requirements. These are put in place to provide you the highest quality service and to protect you as a client.
The forms are offered in two versions for your convenience. The first is an Adobe Acrobat file (.pdf) which will allow you to print out the form and fill it out with a pen. And the second is a Microsoft Word document (.doc) that will allow you to fill in the information in a document format. Please choose the format that is the most convenient for you.
Questionnaire
Prior to scheduling an appointment, the clinic needs to gather information from you to match you and your partner or family to best possible services. To begin this process, we ask for the information contained on this form. After completing the form, you are welcome to email it to the Clinic Director, Dr. Amber Moss at ambermoss@ufl.edu.
Intake form Client version (Adobe)
Intake form Client version (Word)
Psychosocial History
This form is to give your counselor an understanding of who you are, some biographical information, some social and familial history. Overall, giving them a snapshot on paper of the three major realms (biological, psychological and sociological) to best understand how to help you.
This form will be given to your counselor during your first session in the CFC.
Psychosocial History (Adobe)
Psychosocial History (Word)
Informed Consent
This form is required by the University, the state of Florida and all professional organizations. It ensures that you are aware of the treatment process, your rights, the limitations of therapy and consent to engage in the process. Your counselor will review the form with you during your first session and be happy to answer any questions you have over the process.
This form will be given to your counselor during your first session in the CFC.
Informed Consent (Adobe)
Informed Consent (Word)
