Required Forms

Client completing a required form
Required New Patient Forms
Couple in a counseling session

All the * forms are required for treatment/counseling with Theresa K. Cooke MA, LMSW, LLP. Fill out the forms online and click submit for each form when complete. They will be emailed to Theresa.

  1. Download New Patient Information Form
  2. Service Fee Agreement Form*
  3. Symptoms I Feel Form*
  4. Symptoms I Experience Form*
  5. New Patient History Form*

If you are having any problems completing the forms please CONTACT ME!

Appointment Inquiries

SEND MESSAGE

Phone: 810.513.0040 | Email: facestkc@gmail.com | Hours: Monday – Friday, 7:30am – 4:30pm