Forms

New Client Forms & Paperwork


Intake Paperwork:

ALL clients please print, read and sign. Bring to your first session. 

Individuals/Couples - Please fill out one for each person entering into therapy


*Couples/Families: Please fill out the additional Informed Consent for Special Circumstances.

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HIPAA Disclosure Statement for your Rights as a Client


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Release of Information
- If you would like us to coordinate your counseling with any other professionals (such as a psychiatrist or other medical professional), please complete the Release of Information form.

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Contact Form

Please complete the form below to submit an email.
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Restoration Counseling
109 Holiday Court
Suite A2
Franklin, TN 37067 

Phone: 615-852-5192
Email: RestorationCounselingTN@gmail.com