Patient Forms

Click on the links below to find our patient forms

Privacy Policy

Unified Therapy Clinic take patient privacy very seriously. Please read through our policy to know how your information will be handled

New Patient Form

ALL new patients at Unified Therapy Clinic are required to fill out a new patient form. This also has to be updated annually. 

Adult Self Evaluation

Please complete this when coming in for an individual session. 

Couples Self Evaluation

As couples, we often have differing perspectives so we ask that each of you complete this and bring to your first session. Your counselor will not share your evaluation with your partner. 

Teen Self Evaluation

For teens that come to see us, we ask that you have this completed for your first appointment. 

Child Evaluation (Completed by parent or guardian)

We ask that a parent or legal guardian complete a child evaluation for each child coming to see us. 

Fee Schedule

Our current pricing list. *Subject to change*