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Counseling and Psychotherapy

New Client Forms  

Dear New Client,

Welcome to Stillwaters Counseling and Psychotherapy!  From my earliest days as a counselor and therapist, I have been struck by the courage and commitment of people like you who make the often difficult decision to make that first call to schedule an appointment and begin their unique counseling journey.  I count it a privilege to work with people like you who come here to do this good work.  Thank you for selecting me to be your therapist/counselor and allowing me to take part in your growth and movement toward your goals.   

I am very excited about your upcoming appointment and look forward to the journey ahead of us.  To get us started in this process, please click on the links below that pertain to your situation  and download the associated forms.  Please print and review them and fill them out in detail prior to our first session.  Then, bring them to our first appointment.  This will allow us to put the information you provide to good use right away, and facilitate the wise use of your session time.  This makes it possible for us to use our first session to begin the actual process of counseling and psychotherapy rather than focusing on completing forms and intake documents.  

Thank you for choosing Stillwaters Counseling and Psychotherapy.  I look forward to meeting you.

Joanne (Jodi) M. Moore, LPC, NCC, BCETS, CCH    

NOTE:   Please notify us of cancellations at least 24 hours in advance of your appointment time.    more 

Instructions:    Please (1) Read the descriptions for each of the documents noted below, (2) Select those that apply to your situation, (3) Click on the appropriate link for each, (4) Download all applicable forms,  (5) Print each form, (6) Fill out each form (please print),  (7) Sign each form,  (8) Keep a copy of your forms for your records,     (9) Bring all forms with you to your first session, 

Please select the forms that apply to you:

Note:  If two or more clients are seeking counseling together,  please print a full set of appropriate documents for each.  

Please scroll down to see all 4 forms.

1. Professional Disclosure Statement  - all clients 

    *NOTE:  Please read this document carefully.  It contains important information that affects you.

2. New Client Form  - all clients 

3. Directions to Office  - all clients

4. TRICARE Medical Referral Form  - Tricare clients only. Please have your physician or nurse practitioner complete and sign this form before your first session.