FAMILY THERAPY CENTER OF NORTHERN VIRGINIA, LLC
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      • What is an Intern?
      • What is a Resident?
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    • Therapy for Adults
    • Therapy for Teens/Young Adults
    • Calming APPs (SSP & RRP) >
      • SSP & RRP FAQ & Cost
      • SSP & RRP Come With FREE Meditation
    • Family Therapy With Teens
    • In Crisis?
  • Child/Tween
    • Play & Art Therapy
    • Parent Sessions
    • Family Therapy With Children
    • Calming APPs (SSP & RRP) >
      • SSP & RRP FAQ & Cost
      • SSP & RRP Come With FREE Meditation
    • In Crisis?
  • FREE Workshop
  • Admin & Contact Info
  • Meditation

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 You and Your a Loved Ones Today! 

Hours

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

By Appointment

Details

571-733-9736
19420 Golf Vista Plaża
Suite #330
​Lansdowne, VA 20148

Center's Owner Contact Info:                                   

[email protected]. (Founding Owner/Licensed Therapist ) 
[email protected] (Appointments & Inquiries)
  • Home
    • 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
  • Therapy for Teens & Adults
    • Therapy for Adults
    • Therapy for Teens/Young Adults
    • Calming APPs (SSP & RRP) >
      • SSP & RRP FAQ & Cost
      • SSP & RRP Come With FREE Meditation
    • Family Therapy With Teens
    • In Crisis?
  • Child/Tween
    • Play & Art Therapy
    • Parent Sessions
    • Family Therapy With Children
    • Calming APPs (SSP & RRP) >
      • SSP & RRP FAQ & Cost
      • SSP & RRP Come With FREE Meditation
    • In Crisis?
  • FREE Workshop
  • Admin & Contact Info
  • Meditation