Authorization for Release of Information
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This form is optional.

Complete this form only if you would like Healthy Outlook Counseling to communicate with a person or organization about your treatment.

Notice of Privacy Practices

​Please read this notice.

This notice is for your information and reference.  It provides information about the privacy of your health information.

Here are the required forms and additional information to help you get ready for your first appointment.  Forms must be completed before your appointment begins.  

Forms are available at the office.  If you choose to fill out these forms at the office, please arrive 15-20 minutes before your appointment time.

Forms are also available to download below.  If you choose to complete these at home, please be sure to bring your completed Intake Form and signed Consent to Treatment Form to your first appointment.​

Forms

Healthy Outlook Counseling

276 South Main Street, Colchester, CT 06415

(860) 917-8316                 Map

Call (860) 917-8316

for a free 10 minute phone consultation

Currently Accepting New Clients

Office Hours

Sessions by appointment

Monday - Friday and weekends

Intake Form​​

Please download and complete  this form.

This form asks you to provide information about yourself.  It helps us screen for many common problems and begin to learn about your difficulties and goals.

Consent to Treatment Form
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Please download, read and sign  this form.

This form contains information about the services and business policies at Healthy Outlook Counseling.  By signing this form you show that you have read and agree to our policies.