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If you would like the opportunity to read and fill out forms prior to your first appointment, please select which heading applies to you, and fill out the forms listed. Otherwise, please arrive about 15-20 minutes early and we will give you the forms upon your arrival to our office and ask you to complete them in our waiting room. We do understand it's a lot of paperwork, but it's become necessary in the current insurance and HIPPA environment.

 

Telehealth Consent Form: If you are using telehealth for counseling during the Covid-19 Pandemic please click the link below and download and sign the Telehealth Consent Form

Telehealth Consent Form

ADULT FORMS
Please click the link below, download and complete all forms
Client Intake Forms - Adult
CHILD/ADOLESCENT FORMS
Please click the link below, download and complete all forms
Client Intake Forms - Child/Adolescent
JOHN L HOLT, LCMHC
If you are seeing John please download this form as well
LCMHC professional disclosure statement
DEBI PRUITT, LCMHCA
If you are seeing Debi please download these forms as well
LCMHCA professional disclosure statement
Recording consent form
 
 

          CORNERSTSONE PSYCHOLOGICAL SERVICES - 2711A PINEDALE ROAD, GREENSBORO, NC 27408 - [P] 336.540.9400 - [F] 336.540.9454

      CORNERSTONE PSYCHOLOGICAL SERVICES - 2711A PINEDALE ROAD, GREENSBORO, NC 27408 - [P] 336.540.9400 - [F] 336.540.9454