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Office Hours
Monday-Friday, 9am-6pm

New Directions Counseling Corp.
Dr. Michael D. Robertson
1200 Airport Heights Drive
Suite 170
Anchorage AK 99508

(907) 929-5258
Fax (907) 929-5256

 

Forms to Download

New Direction Counseling forms are available here in pdf format. Feel free to fill them out prior to your appointment. We are happy to help you with any questions you might have pertaining to the forms.

Adult Intake Information form

A basic form of client contact information, reason for services and referral source.

Adult Psychotherapy Consent form

A form that provides information to allow clients to make informed decisions regarding participation in psychotherapy.

Child Intake Information form

A basic form with child's name, parent contact information, reason for services and referral source.

Child Psychotherapy Consent form

Child Informed Consent form: a form that provides parents information to make in informed decisions regarding their child's participation in psychotherapy.

Child Facesheet form

A form that allows parent(s)/guardian(s) to note symptoms, current or past prescribed medications and current or past treatment providers.

Insurance form

A form to provide us with current insurance information

Release of Information to New Directions Counseling Corp

A form that allows us to receive information about you from identified professionals (e.g. current or past health providers, schools, or other professionals) that would help us gain a better understanding of you and provide better treatment. This Release of Information (ROI) expires after 1 year.

Release of Information from New Directions Counseling Corp

A form that allows us to provide information about you to identified professionals (e.g. current or past health providers, schools, medical providers) that would help other professionals provide better treatment to you. This ROI expires after 1 year. HIPPA form: A form that explains how medical information about you may be used and disclosed and how you can get access to this information.



NOTICE and Disclaimer: The information accessed at this site is for general educational purposes only. Online browsers should consult with licensed professionals (physicians, clinical psychologists, clinical social workers, etc.) if they have questions whether they may be in need of psychological or any other form of treatment. If this is a medical emergency, please call 911.