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Please download and complete the forms below. Adobe Reader is needed to view and print them.

Informed Consent for Denise

Informed Consent for Robin

Informed Consent for Jennifer

Electronic Intake

NOPP

Permission to Treat Minor

ADOL Agreement

Client Satisfaction Form

Wellness Assessment Adults

Wellness Assessment Youth

Visit Us:

457 Ridge Street
PO Box 692
Bloomsburg, PA 17815

Pay Online Here

Contact Us:

Fax: (570) 356-2207
Denise Caldwell 570-356-2206 ext. 102
Maurissa Laudeman 570-356-2206 Ext 103

Our services are confidential and we cannot discuss your situation unless you give specific, written permission for a specific individual or agency. We are bound by the professional ethics, standards, and laws of Pennsylvania and the federal government. We will discuss this with you more thoroughly in our first few meetings.

Emergency Mental Health Numbers:

Tapline number at 1-800-222-9016 for Columbia, Montour, Snyder, or Union Counties and 1-855-313-4387 for Northumberland County. (or 211 PA for your local emergency mental health number in your area).

National Suicide Prevention Lifeline call or text 988 or to chat https://suicidepreventionlifeline.org/chat/, The Trevor Project 1-866-488-7386 for LGBTQ individuals.
© Caldwell Family Counseling, LLC 2018. All Rights Reserved.