Forms

For Clients

For All New Clients

Please download, print and complete these 2 forms and bring them with you to your appointment.

1. Mandatory Confidentiality Agreement (PDF 1 mb)

Required by the State of Colorado

2. Office Policy (PDF 1 mb)

Covers the basics regarding cancellation policy, payments and availability outside appointments.

Also, complete the appropriate form/s below:

New Adult or Teen Client Information Form (PDF 1 mb)

For male or female, teen or adult individual counseling. Some background information helps us get up to speed. 

New Teen Client Confidentiality and Information Form (PDF 1 mb)

For Teen counseling. Defines how teen client privacy in managed. 

New Couple's Consent Form (PDF 1 mb)

For couples counseling. Asks couples to agree to disclosure between partners and I'm unavailable to attend legal proceedings or consult for custody matters.

New Couple's Information Form (PDF 1 mb)

For couples counseling. Some background information helps us get up to speed. 

For Other Practitioners and Physicians

Release of Information Form (PDF 1 mb)

Patients or clients can allow their service provider to discuss treatment with a designated professional.

Ric Taylor, MA
9362 Teddy Lane, Suit 206
Lone Tree, CO 80124
720-924-1144
ric@touchbasecounseling.com
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Rate: $125 per session • Insurance: Out of network only • Credential: NLC.0103508

Areas served: Highlands Ranch, Denver, Centennial, DTC, Greenwood Village, Aurora.