The following list of forms are related to your care.

Please click on the appropriate form and download it to your computer. You can use Adobe Reader to fill the form out electronically and then send the form(s) back to This email address is being protected from spambots. You need JavaScript enabled to view it..

You can also download the form, print it out, complete the form in hard copy, and return it to my office.

 

Client Intake Form - Complete this form prior to your first session so that your therapist can appropriate assess the areas that might be discussed during your session.

 

Release of Information - Complete this form to give your consent to have any medical records released to Marita Beth Earle for the purposes of treatment.

 

Practice Policies - This form describes to you the policies that Middle TN Therapy regards when providing care to you. This includes the confidentiality policy, professional services, risks and benefits, fee policy, and Marita Beth Earle's credentials to treat you.