Client Information Form

Please fill out this form and bring it to your first visit. The information that you provide will help me develop a clear and focused understanding of who you are and what you hope to gain from the counseling experience. 


Amy M. Cohen, LCPC


 5420 Klee Mill Road, Suite 4  Sykesville, MD 21784                Cell:  443.831.8089      Fax:  1.443.327.4636

Amy M. Cohen, LLC © 2013  |  Privacy Policy

informed consent & Office Policies

You will be asked to sign this form for yourself or for your minor child as part of your first visit.  Please take some time to read it in advance.  I would be happy to answer any questions you might have.


Release of Information

Please fill out this form if you wish for me to have contact with any of your educational or health care providers.  The purpose of this collaboration is to better treat you in a holistic manner.