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Triad Counseling and Clinical Services, PLLC

Comprehensive Counseling and Psychological Services

FORMS & DISCLOSURES

Prior to your scheduled appointment please complete the appropriate paperwork as well as your counselor’s professional disclosure below. We ask that you bring these forms and your insurance card to your scheduled in person appointment or email for telehealth sessions. Contact admin staff for email instructions. If emailing, the forms and insurance card must be submitted 24 hours before the appointment.

please note: 

All NO SHOW and late cancellation appointments will be billed at the full rate. These fees are not billable to your insurance. Fees must be paid before your appointment can be rescheduled. If you are a first time client and give us less than 24 hours notice about rescheduling your appointment, we will not reschedule you again in our office.


TO SIGN DIGITALLY: 
Download the file to your computer or device and open in a PDF viewer such as Adobe Acrobat. After signing, save the file with a new name.
For in-person sessions, print and bring the forms with and for telehealth sessions, contact the admin staff for instructions on how to email.


  1. Click the Download button of the form to be filled out. Download and save the file to your device.
  2. Open the file in Adobe Acrobat or a pdf viewer program. Fill out the fields with your information and digitally sign the form.
  3. Once you’ve completed all fillable fields, click ‘File’ > ‘Save As’ in the navigation.
  4. Add your first and last name to the file name. Click Save.

1) Click the Download button of the form to be filled out. Download and save the file to your device.
2) Open the file in Adobe Acrobat or a pdf viewer program. Fill out the fields with your information and digitally sign the form.
3) Once you’ve completed all fillable fields, click ‘File’ > ‘Save As’ in the navigation.
4) Add your first and last name to the file name. Click Save.

NEW CLIENT FORMS

Adult Intake FormsDownload
Child Intake FormsDownload
Credit Card AuthorizationDownload
Informed Consent for Telehealth ServicesDownload

Professional Disclosures *new clients, please complete:
Locate your counselor in the list below and click their name or download button to open and download their professional disclosure.

*Click Here to Find Your Counselor

in alphabetical order by last name

Michelle Barrett-HiltonDownload
Jessica P. Beckman – PDSDownload
Jamie CrockettDownload
Star DayeDownload
Sara DeHart-YoungDownload
Karen ElliottDownload
Katherine GlennDownload
Kristen Gregory PattersonDownload
Donna HoodDownload
Connie JonesDownload
Ted KeatonDownload
Jennifer Kiszely-BresslerDownload
Eugene NaughtonDownload
Jamian NewtonDownload
J. Scott YoungDownload

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Greensboro Location

(336) 272-8090
Fax: (336) 272-0094

5587 D Garden Village Way
Greensboro, North Carolina 27410

Business Office Hours
M-F: 9am – 5pm
S-S:  Closed

Triad Counseling and Clinical Services, PLLC logo
High Point Location

(336) 882-2812
Fax: (336) 882-8632

1623 York Avenue Suite 104
High Point, North Carolina 27265

Business Office Hours
M-F: 9am – 5pm
S-S:  Closed

Copyright © 2023 · Triad Counseling and Clinical Services, PLLC · Terms and Conditions · Privacy Policy

  • In case of inclement weather, please contact your individual therapist for information on cancellation or telehealth options available.Visit Contact Page
  • TELEHEALTH UPDATE: We have received notice from several insurance carriers that Telehealth services will be ending soon.
    Please check with your insurance company to verify that your individual plan is still covering Telehealth sessions.

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