Book Appointment

Patient Intake Form

Before you begin...

Please select your therapist

Step 1

Please download and fill out the Lyon Counseling Patient Intake Form

Please note: You must bring this with you in-person, or email it to your therapist before your first appointment

Step 2

Please provide your first and last name followed by your email address

First Name

Last Name

Email

Step 3

Please read and acknowledge the following items...

I have read and agree to the Fees & Charges

I have read and agree to the Informed Consent

I have read and agree to the Privacy Practices

Signature

Sign Here