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Therapy Forms

If you are new to Segal Psychotherapy, you will need to complete some forms before arriving for your first session. These forms will take some time to complete usually about 20 minutes. Please read the Psychotherapy Agreement prior to your initial counseling session. This form contains information about the counseling process and information on your rights as a client. It also lets you know what my responsibilities as your counselor are. Please print out and sign the Acknowledgement form to confirm that you have read and understand the Psychotherapy Agreement.

Counseling Forms

If you are seeking individual counseling, please print and complete:


If you are seeking couples counseling or marriage counseling, please print and complete: