Mental Health Counseling WV Therapy | KPCC Counseling

Forms & DownloadsKPCC2022-08-17T12:14:56-04:00

Forms & Downloads

Privacy & Disclosures

KPCC Notice of Privacy Practices (HIPAA)

KPCC Professional Disclosures Statement

Please download and review.

Forms for Adults

Adult Counseling Intake Forms

Telehealth Counseling Release Form

For adults ages 18 and older, please download the Intake Form, read, complete it, and return it to your counselor by your first session. Please also complete and submit the Telehealth Release Form if you are participating in Telehealth sessions.
Couples, please complete one set of forms for each person. Thanks!

Forms for Teens (we only see children ages 13 or older)

Teen Counseling Intake Form #1

Teen Counseling Intake Form #2

Both forms are to be completed by parents or guardians of clients who are 13 – 17 years of age. Please download and complete both sets of forms.

Office Locations

Directions to Counselor Offices

We have counselor offices at four different locations. Please check your counselor’s location before arriving at your appointment.

Information Release

Full Client Information Release Form

Only fill out these forms if you are wanting your records released to someone.

Coaching Consent

Coaching Client Consent Form

These forms are for folks who are taking advantage of our life and executive coaching services.