Please print a copy of each form (Last form for people in recovery only needs to be filled out if you have already ceased using substances).

****PLEASE NOTE**** You can email the forms to jason@lighthousecc.online , This is a HIPPA compliant encrypted email to ensure the privacy of all our clients.

Lighthouse Counseling Center Intake Forms

Lighthouse Counseling Center Intake Form (docx)

Download

LIGHTHOUSE Consent for Treatment and Cancellation Policy (docx)

Download

LIGHTHOUSE DMHAS Privacy Rights Receipt (docx)

Download

LIGHTHOUSE Authorization for Use or Disclosure of Protected Health Information (docx)

Download

LIGHTHOUSE Additional Intake Information for People in Recovery (docx)

Download