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Forms

Please print and complete the following intake forms and bring those to your first appointment.

Individual Adult Intake: 
Please read HIPAA and Client Bill of Rights.


Adolescent/Minor Intake:
 
Parents, please complete the forms for your child. Please read HIPAA and Client Bill of Rights.

 
Couples Counseling Intake: 
Please read HIPAA and Client Bill of Rights. Both parties must sign each form.

 
Note: To download Adobe Acrobat Reader for free, click here.

Contact Me

LOCATION

Availability

Ina Lasmane, MA, LMFT

Monday:

12:00 pm-7:00 pm

Tuesday:

12:00 pm-7:00 pm

Wednesday:

10:00 am-4:00 pm

Thursday:

12:00 pm-7:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed