Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Client Information Sheet

Consent for Treatment

Release of Information

Telemental Health Informed Consent

317-886-9589

Contact Melanie
melanie@jrnycounseling.com

Contact Holly
holly@jrnycounseling.com

Send Us a Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.