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

 Click here to download the informed consent


Click here to fill out the new client paperwork online



Click below to download a copy of your counselor’s disclosure statement:

Amber Lange

Pamela Bush

Patricia Pollock

Louise Keinath

Click below to download Bedford Behavioral Health’s  Health Insurance Portability and Accountability Act Privacy Policy:

HIPAA Privacy Notice