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New Clients
Thank you for chosing Carlock & Associates.
PLEASE NOTE: We do not accept credit cards. Your copay in cash or by check is due at the time of service or there is an additional $10 charge.
You will need to print the following forms, fill them out, sign them, and bring them with you to your first appointment. You will need Adobe Acrobat Reader to view these client packs. If you do not have it you can download it for free at www.adobe.com
Clients over age 18
Clients over age 18 download forms here.
Please print out all forms, and fill out everything in its entirety.
For couples/marital you will need to print out two copies of the “Client Data Form” one for each of you to fill out. It is not necessary to print out two copies of the entire client pack. All you need two copies of is the Client Data Form.
Clients under age 18
Clients under age 18 download forms here
Parent or Guardian: Please fill out all forms with the child/adolescent’s information (i.e. name, birthdate, social security number) but sign your name. Have the adolescent (age 13 or older) fill out the Adolescent History form about him/herself. If the client is under age 13 please disregard the Adolescent History form.
Directions to both the Dayton and Vandalia offices are included with this, as well as a form listing our fees.
Please make note of the no show and late cancelation fees on that page. If you need to cancel an appointment we require 24 hours advance notice. If you give less than that you will be charged for the full fee of the session, because we cannot file it with insurance. The same thing goes if you do not show up for your appointment, and you do not call.