Next Steps

Please consider reviewing and completing the following forms prior to arriving for your initial appointment. Feel free to download and complete or arrive 15 minutes in advance and we will leave a copy for you in the waiting room for you to complete. Inevitably it will take some time to get to know one another. Complete these forms as honestly as you can so we can get started and you can always make adjustments as we learn more about the issues bringing you here.


We are located on the second floor, waiting room on the right, and unfortunately do not have an elevator. We do not always have front desk staff, so come on in and take a seat. We will be with you for your appointment.


FOR CHILDREN & ADOLESCENTS: (For individual only)

Parent Introduction (*for youth under 18 only)

Adolescent Introduction (*for youth over 13)

Permission to treat minor child (*for youth under 18 only)

Release of Information
Payment form

Service Agreement

FOR ADULTS: (Please complete all forms)

Adult Introduction*(individual counseling)

Couples/Relationship Introduction (*couples/relationship)
Service Agreement

Release of Information
Payment form

* For pregnant or postpartum women only



Intake Form Minor

Intake Form Adult

Release of Information

Service Agreement

Permission to treat minor child (for youth under 18)

Testing payment form (for insurance)

Testing payment form (for private pay)

HIPAA Document 


PAYMENT: Strong Roots Counseling accepts BCBS, Tufts, and Optum, AllWays, Health Plan Inc, United Behavioral Health, and Harvard Pilgrim; please contact us to learn more about coverage or contact your insurer directly. We are also happy to create receipts or a statement for your out of network insurance benefits/PPO or medical flex spending accounts. We accept cash or check for co-payments and fees; please make checks out to Strong Roots Counseling.

1387 Washington St, West Newton, MA 02465

©2019 by Strong Roots Counseling

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