Counseling Intake Form

Schedule an intake appointment for counseling services. An intake is an opportunity to discuss your presenting concerns and develop a treatment plan with a counselor based on your needs.

CORE Referral Form

Make a referral for CORE (Counseling, Outreach and Referral for the Elderly) services. CORE is a mental health, substance use disorder counseling and care coordination program for people 55 and older.

Daybreak Clubhouse Referral Form

If you or a loved one are interested in joining Daybreak, this form must be completed by your doctor and emailed to Alicia Nicholson at

Medical Release Form

Request for and release of protected health information. Click here for filable/printable form.