Mental Health & Counseling Services
for Adult, Children & Adolescents
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(972) 697-6822
4100 Fairway Drive, Suite 200
Carrollton, TX 75010
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Intake Forms
Intake Forms
Intake Forms
Below are the intake forms necessary for you to fill out before your first appointment.
Save time by filling out the forms now, or you can simply fill out the forms when you come in.
Forms*
Patient Information Form
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Child Adolescent Form
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Insurance Form
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HIPPA Form
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Payment Policy
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Home
Location
Intake Forms
Lakeside Life Center
Shelly Butler Therapy
4100 Fairway Drive Suite 200
Carrollton, TX 75010
Phone:
(972) 697-6822
s37butler@aol.com
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