907-622-1002

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  • More
    • Home
    • About Us
    • Client Portal and Forms
    • Services
    • Contact / Map
    • Make a Payment

907-622-1002

  • Home
  • About Us
  • Client Portal and Forms
  • Services
  • Contact / Map
  • Make a Payment

Peak Counseling

Peak CounselingPeak CounselingPeak Counseling

Forms - Client Portal

Before your first appointment, we will give you access to your own private, client portal.  The client portal will allow you to fill out your forms and check your schedule.  Click below to access your client portal.

Access Your Client Portal Here

As a new client, you must review and understand your client rights:​  Health Insurance Portability and Accountability Act of 1996 (HIPAA)​.
More information can be found on the U.S. Department of Health & Human Services website by CLICKING HERE.  Or you may request a copy at our office.

Release of Information Form Print Version Only:  


Fill this form out if you would like to authorize our office to communicate or exchange information (such as your records) with another office or individual.

Release of Information - ROI (pdf)

Download

Child Therapy - When Parents are in High Conflict


 **Important: This contract is only required for parents who are either separated / divorced or are in the process of a separation / divorce that continue to be in a high state of conflict or disagreement regarding custody and/or high conflict regarding co-parenting their child together.  Effective co-parenting means that both parents can communicate in writing AND in person the needs of their child and are both able to implement an agreed parenting plan without regular conflict.  Sure, all parents (even those not separated or divorced) have conflict regarding co-parenting.  This contract applies to those parents where co-parenting conflict is happening most, if not all, the time between parents.   

Parent Agreement (pdf)

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Copyright © 2017 Peak Counseling  (A Company of Eric Unruh Counseling, LLC) - All Rights Reserved.  907-622-1002