Motivations Counseling – Client Forms

New Clients:

Please print and complete one of the following "New Client Forms" packets and bring it with you to your first therapy session:

Individual Adult (18+) Packet

Child/Teen Packet

Couples Packet

Individual Adult (18+) Packet - Ruba Afifi, Therapist

Child/Teen Client Packet - Ruba Afifi, Therapist


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Existing Clients:

If you need us to release your therapy/treatment information to a third party, please complete the following form authorizing us to do so:
Authorization to Release Information

For EMDR Therapy sessions, please complete the following informed consent form prior to the first treatment:
EMDR Informed Consent

For clients needing Telehealth Counseling, please complete an informed consent form prior to the first treatment:
Telehealth Informed Consent - Individual/Teen
Telehealth Informed Consent - Couples

Please print and fill out the required forms.  Bring them with you to your next scheduled appointment
or scan and email them to the following address:

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