Michael A. Gentry, JD, LCSW

Individual and Family Counseling

Primary Location
8115 E. Indian Bend Rd., Suite 119
Scottsdale, Arizona 85250

​480-269-1727
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  • HOME
  • ABOUT
  • SERVICES
  • FORMS
  • ADDITIONAL RESOURCES
  • APPOINTMENTS & CONTACT INFO

FORMS​

INITIAL INTAKE DOCUMENTATION: 

Before completing these forms, please call 480-269-1727 to confirm that I am taking new clients. Once you have done so, please print and complete the following 5 items, then bring them with you to your first session.
  1. Client Registration and Confidential History​
  2. Symptom Checklist
  3. HIPAA Notice of Privacy Practices
  4. Outpatient Services Contract
  5. Appointment Cancellation Policy
​
​Please complete and bring the above 5 forms to your initial session.
OTHER FORMS:
  • Authorization for Release of Confidential Information
           (Required when you want your counselor to obtain or share information with other individuals/agencies)
  • Therapy Collateral Agreement 
           (Required when you want a family member or significant other to participate in your therapy)
​
The forms below may be requested sometime during your therapy. You do not need these for your initial appointment.
​
  • ​Family of Origin Questionnaire
  • Trauma History Worksheet

​We cannot avoid suffering but we can choose how to cope with it, find meaning in it, and move forward with renewed purpose.
― Viktor E. Frankl, Man's Search for Meaning
480-269-1727  |  Appointments & Contact Info​  |  © 2019 www.gentrytherapy.com