Forms

Prior to your scheduled appointment, please print and complete the Disclosure Statement and Intake Form.

  Download Disclosure Statement   Download Intake Form  
If you are having thoughts of suicide please call the Alliance Access Crisis Line, available 24 hours a day at (800) 510-9132, and a licensed clinician will evaluate your situation and assist you in finding the right kind of help. If you are experiencing a medical emergency, call 911 for immediate help.

If you have questions regarding Wellness Services, please send inquiries to [email protected] (919-886-5942).