New Client Forms

For your convenience, you can download and complete the New Client Forms, Notice of Privacy Practices, and EMDR Assessment Forms before you come to your first session.

Please plan to spend approximately 30 minutes to complete the forms.  Due to the information required, it is best if you complete the forms at your home or office where you have access to your personal information.  Thank you.

Three-Day Intensive Application

Please complete the Three-Day Intensive Application and Dr. Hollenbeck will contact you to set up an Intensive Phone Interview.  

New Client Intake Forms (Required)

Please complete the forms in their entirety prior to your first appointment to avoid spending your session time filing out the forms.

Notice of Privacy Practices (Required)

Please read and keep Pages 1-3 and complete Page 4 to bring with you to the first appointment.

Disclosure Authorization

Please complete this form if you would like to give authorization for Dr. Hollenbeck to obtain copies of records from, share your records with, and/or consult with other professionals such as psychotherapists, medical doctors, psychiatrists, in-patient treatment facilities, etc. about your former or current treatment.

No Secrets Policy

All couples and/or families must read and sign this policy and bring with you to the first appointment.  Individuals seeking counseling alone do not need to complete this form.

Sex Addiction Treatment Informed

All Individuals seeking treatment for sex addiction must read and sign this policy and bring with you to the first appointment.

EMDR Assessments & Consent Form

Please only complete EMDR forms if you are interested in EMDR Therapy.  These are  not  part of the New Client Forms required for your first session.