First Session Forms (Texas Office)

Please print and complete these forms prior to your first individual or group session. If you have questions about any of these forms, I will be happy to discuss them with you during our initial appointment.

Required Forms

1.a. New Client (CHILD) Intake Form

Please complete a separate form for each child that will be meeting with Mike Jahn, MA, LMFT.

1.b. New Client (ADULT) Intake Form

Please complete a separate form for each adult person that will be meeting with Mike Jahn, MA, LMFT.

2. Disclosure & Consent for Services

Please complete a separate form for each person that will be meeting with Mike Jahn, MA, LMFT.

3. HIPPA Notice and Receipt

Please provide signature pages for each person that will be meeting with Mike Jahn, MA, LMFT.

Optional Forms

Release of Information

Authorization for release of information to specified parties (i.e. physicians, spouses, etc.)

Use of Credit Card Consent

Please fill out this form completely and notify Mike Jahn, MA, LMFT if or when any of this information changes.