Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Client Intake Form

Information Sheet

Limits of Confidentiality

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

 

Contact Today



Office within b.mindful Louisville
1949 Goldsmith Lane, Ste. 103
Louisville, KY 40218

tomeika@leavellcounselingllc.com
(502) 317-6521






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