Magill Counseling Associates, LLC
Magill Counseling Associates, LLC
in Ephrata, PA Ph: 717-219-5711
forms

Our Forms

Below are links to the forms most often needed for clients. If you do not see the form you need, please contact us at 717-219-5711 or email us at info@magillcounseling.com.  


If you are a provider, please visit our Provider Resources page first.


Client Intake Forms

These forms - Consent and Intake Forms are required to be completed within 24 hours of scheduling your initial appointment.

Intake Questionnaire
Child Consents (13 or younger)

Release of Information

This form is needed for us to speak with other providers, family, etc. on your behalf. It can be revoked by you at any time.

Release of Information Form

Insurance Update Form

This form is needed when your insurance information changes, or when going from self pay to insurance, etc.

Insurance Update Form

Document Upload Form

Please use this form to directly send us documents. This is a secure upload form, and your counselor, billing, etc. will get your documents shortly after it is uploaded.

Document Upload Form

Screens

These screens are included in the intake paperwork. You may be asked to complete these screens again during you time in counseling with us.

Screens

Records Request

If you would like a copy of your records, or if you need a copy of your records sent somewhere, please complete this form. We will process record requests within 1 business day.

Record Request