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Therapy Session

Client Forms

You can print the forms below from your computer using Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader on your computer or device, you can download it by clicking the Download Adobe Acrobat Reader button.

The online form below is the final form that must be completed prior to receiving counseling services. Please enter your information in all required fields shown below. By checking the agreement box at the bottom of the form you are verifying that all information entered is valid and correct to the best of your knowledge. Click submit form once all information is entered and the agreement box has been checked.

Printable PDF Forms to be completed by hand and returned to Marriage Counseling Center.

Insurance Verification Form

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Clarks Summit, PA

Patient Forms

Download your forms prior to your appointment.

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