FAMILY THERAPY CENTER OF NORTHERN VIRGINIA, LLC
  • Us
    • Meet the Team >
      • What is an Intern?
      • What is a Resident?
    • Blog: Varied Topics by Our Clinicians
    • Blog: Lyme, PANDAS & Other Infections in Children & Adults
  • Adults & Teens
    • Individual Therapy
    • Couples Therapy
    • Family Therapy
    • In Crisis?
  • Child/Tween
    • Play Therapy Explained
    • Issues We Treat
    • Playful Tele-Health
    • In Crisis?
  • Meditation
    • 8 Week Stress Series
  • Admin & Contact Info
    • Paperwork for Chloe Cook Clients
  • For Other Therapists
    • Play Therapy Trainings >
      • Play Therapy Training
      • Play Training: Jan 22, 2021
      • Play Training: March 19, 2021
      • Grievances & Refunds
    • CE Trainings
    • Supervision: RPT

Paperwork Needed at the First Appointment for Clients of Chloe Cook:
Choose one from Category 1 & 

1. Choose the Appropriate Questionnaire 

Questionnaire: Child and Adolescent
File Size: 58 kb
File Type: pdf
Download File

Questionnaire: Adults
File Size: 92 kb
File Type: pdf
Download File

Questionnaire: Couples
File Size: 101 kb
File Type: pdf
Download File

Questionnaire: Family Therapy
File Size: 60 kb
File Type: pdf
Download File

Informed Consent: Chloe Cook, LMFT
File Size: 40 kb
File Type: pdf
Download File

3. HIPPA Privacy Act Info. To Print for your Files (we do not need it)

HIPPA
File Size: 63 kb
File Type: pdf
Download File

4. Other Documents That May/May Not be Useful During the Counseling Process

Release of Information (Print this if you would like to give permission for us to receive or give info about you from/to someone else)
File Size: 84 kb
File Type: pdf
Download File

Tele-Mental Health Appointments (Fill out if you will be seeing your therapist over the internet and not in person)
File Size: 18 kb
File Type: pdf
Download File

Get Help for Yourself or a Loved One Today! 


Hours

M-F: 8am - 9pm
Sat: 8am -2pm

Telephone

571-733-9736

Center's Owner Contact Info:        Practice Address:

Gabrielle@FamilyTherapyNova.com.                       19420 Golf Vista Plaza #330
Owner/Licensed Therapist                                     Lansdowne, VA 20176
  • Us
    • Meet the Team >
      • What is an Intern?
      • What is a Resident?
    • Blog: Varied Topics by Our Clinicians
    • Blog: Lyme, PANDAS & Other Infections in Children & Adults
  • Adults & Teens
    • Individual Therapy
    • Couples Therapy
    • Family Therapy
    • In Crisis?
  • Child/Tween
    • Play Therapy Explained
    • Issues We Treat
    • Playful Tele-Health
    • In Crisis?
  • Meditation
    • 8 Week Stress Series
  • Admin & Contact Info
    • Paperwork for Chloe Cook Clients
  • For Other Therapists
    • Play Therapy Trainings >
      • Play Therapy Training
      • Play Training: Jan 22, 2021
      • Play Training: March 19, 2021
      • Grievances & Refunds
    • CE Trainings
    • Supervision: RPT