Michael M. Christian, Ph.D., LPC-MHSP, NCC, CSAT

Patient Forms

Instructions to Complete and Submit Patient Forms

  • If you do not have adobe reader on your computer, you will need to download Adobe Acrobat here: http://get.adobe.com/reader/
  • Once installed, please save the of PDF form that you are completing to your computer. You will need to repeat this step for each of the forms you are asked to complete and submit. DO NOT complete all the forms…just the ones you are requested to complete.
  • Open the PDF form that you saved with Adobe Reader. You cannot open the file with any other software. You MUST open the saved file with Adobe Reader.
  • Once you open the file, complete the form by providing ALL the information that is being requested. Please be sure and complete all blanks. If a question is not applicable to you, then type N/A.
  • Once you complete the form, click "Save as." Name the file with your first and last name and the name of the form. Again, you will complete this step for each form you are requested to submit.

    For Example: JoeSmithIntake.pdf
    For Example: JoeSmithPracticePolicies.pdf
    For Example: JoeSmithCreditCardAuthorization.pdf
    For Example: JoeSmithAdultQuestionnaire.pdf
    For Example: JoeSmithReleaseforEmailofTextMessaging.pdf
    For Example: JoeSmithReleaseofInformation.pdf
    For Example: JoeSmithSexHealthyQuestionnaire.pdf
  • Once the PDF is saved then attach ALL the saved forms to an email and send it to michael@intimacyseekers.com
  • As a back up, print hard copies of all forms and bring with you to your counseling session. If you have questions, feel free to call Dr. Christian at 615.604.6853

Forms

  • Download Practice Policies [ .pdf ]
  • Download Adult Questionnaire [ .pdf ]
  • Download Credit Card Authorization Form [ .pdf ]
  • Download Release for Email or Text Messaging [ .pdf ]
  • Download Release of Information Form [ .pdf ]
  • Download Sex Health Questionnaire [ .pdf ]

Contact Michael

All calls are confidential & treated with utmost professionalism.

615.604.6853

Email Michael