At this time we are only accepting forms completed online or by fax.
If preferred, you can fill out the form by hand by selecting the "Print Version" below and faxing it to our office at: 907-622-8808.
NOTE: We use the Company DocHub for online forms and signatures (forms below). After clicking for an online form (below), the form will open and you will need to press "fill a copy" (top right of form) to fill out and sign the form. This requires that you create an account. If you would rather not create an account with DocHub, please contact us at 622-1002 and request that we email you a copy. You can then sign the document without having a DocHub account.
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.
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.
Copyright © 2017 Peak Counseling (A Company of Eric Unruh Counseling, LLC) - All Rights Reserved. 907-622-1002