Intake Forms 2018-07-09T17:19:17+00:00

To download and print our Intake Forms, please click, below:

Adult Intake Packet

Child Intake Packet

Patient Rights and Responsibilities (Medicaid Clients Only)

Forms are PDFs. Adobe Reader required to view and print forms.

If you would like to set up an appointment or have any questions or concerns please contact Miracles Counseling Centers at ext 10. Together we will make a decision about who will work best for you to begin your path to healing. Remember to stop, breathe in through your belly and find some good in your day.