The following forms will be used for your first intake visit. Please feel free to print a copy and complete the forms before your appointment. This is not a requirement. All forms will be provided to you during the time of your initial appointment. There’s also an option to complete documents electronically through My Thera Book. You will be able to create an account and complete all of the required documents electronically. Please send an email if you have any questions or issues with completing the forms!

Email: admin@alpinesempowermentagency.com

Adult Intake Form

Notice of Privacy Practices