Counseling Forms
Click below to download counseling forms.
Bedford Behavioral Health is here to meet your counseling needs. We offer individual and child and teen and couples counseling for mental and behavioral health. The counseling forms below are meant for new and returning clients. If you have any questions about the forms do not hesitate to contact 734-807-0162. Additionally, you can email solutions@bedfordbehavioral.com.
Counseling forms for Intake and assessment, disclosure, HIPAA, confidentiality, ADHD, Alcohol Assessment, Free Mental Health Check-Up.
Counseling forms for all Clients
Counseling form for Adults
- ages 18 and up - biopsychosocial history form_adult
- Couples and family BBH Couple or Family Form
- Genogram Genogram
- Values and Activities values and activities
Counseling forms for children and teens
- Children ages 1-17 Child and Adolescent Questionnaire
- Teenagers ages 13-19 BBH Adolescent Informed Consent - all adolescents
Release of Information counseling forms
- This document needs to be signed if there is an agency or person you want to receive information about your counseling:
Counseling form for any alcohol or drug problem
- Alcohol or drug problem: triggers
Click below to download a copy of your counselor’s disclosure statement counseling form:
Amber Lange disclosure statement
Patty Pollick Disclosure Statement
Mary Merril _ Disclosure Statement
Click below to download a copy of the HIPAA Privacy Policy: