Counseling Services - Heath, OH

(740) 522-0009

  • Home
  • About
    • About Bridging Connections
    • A Virtual Tour of Our Office
  • Staff
  • Services
    • Our Services
    • Counseling Rates
  • Resources
  • Insurance
  • Contact
  • Make a Payment
  • Client Forms
  • Nurtured Heart Approach Class

Client Forms

Please print, read, and complete the appropriate forms below, and bring them with you to your first counseling appointment with us. Thank you. We look forward to meeting you!

    Intake Forms for Adult Clients:

  • Bridging Connections Adult Information Form – Please complete all areas.
  • Bridging Connections Office Policies – Please read and sign.
  • Bridging Connections Notice of Privacy Practices – Please read.

 

    Intake Forms for Clients Under the Age of 18:

  • Bridging Connections Minor Client Information Form – Please complete all areas.
  • Bridging Connections Parent Questionnaire – Please complete.
  • Bridging Connections Office Policies – Please read and sign.
  • Bridging Connections Notice of Privacy Practices – Please read.

 

Release Form – necessary if you wish for us to coordinate with another provider:

Bridging Connections Consent for Release of Confidential Information – Please complete and sign.

Contact Us

  • 30 Custer Road
  • Heath, OH 43056
  • (740) 522-0009
  • Home
  • About
  • A Virtual Tour of Our Office
  • Staff
  • Our Services
  • Resources
  • Insurance
  • Contact
  • Pay Your Bill
  • Client Forms
  • Counseling Rates

Web Design and Hosting by RevLocal

© Copyright 2023 Bridging Connections. All rights reserved.