For individuals and couples, please fill out the following intake forms:
- For Abbey's clients, please only fill out Abbey's Intake Paperwork.
- For all others:
- Informed Consent (click your therapist's name)
- Michael Ciaccio
- Michael's Telehealth Informed Consent (for video counseling only)
- Chris Ellman
- Mark Martinez
- Julie Nielsen
- Michael Ciaccio
- Center for Healing Assessment
- Social History
- Informed Consent (click your therapist's name)
For couples, in addition to the above forms, please fill out the following:
These will give us a picture of where you are and help us develop a collaborative treatment plan.
For men struggling with pornography:
Click on the link below to fill out a 10-minute assessment that will help you see the extent of the problem. You will then receive a score ranging on a continuum from 1-7 along with practical tips for moving forward. You may enter your therapist's email address at the end of the assessment to have it sent to him/her. This assessment was developed by Dr. Kevin Skinner. http://www.assessingpornaddiction.com/