FORMS

If you are a new client, please print and complete the forms below prior to your first session.  

If you prefer, you may also plan to arrive at my office approximately 15 minutes prior to the start of your initial session and fill them out in the waiting room.  Please let me know if you decide to use this options so that I can leave the forms out for you.

Client Intake Form

Informed Consent for Treatment/Policies and Procedures

Informed Consent for Online Counseling (online therapy only)

Credit Card Authorization form (must be completed by all clients)

If you would like me to speak to another person/provider about your current and/or past treatment, please complete the following Authorization to Disclose Information form.

To download Adobe Acrobat Reader for free, please click here.

  • Facebook Social Icon

Seven Pines Office Park
8116 Cazenovia Rd
Manlius, NY 13104

Cazenovia     Chittenango     DeWitt     East Syracuse     Fayetteville     Jamesville     Manlius      Syracuse

©2017 by Christina L. Gmyr, LMHC, NCC. Proudly created with Wix.com