Brassfield Center for Psychotherapy and Personal Development

Registration Forms

If you have already scheduled an appointment with a therapist at Brassfield Center
for Psychotherapy and Personal Development, please print and complete the forms listed below.
Each therapist has provided the forms necessary for registration for their services.

A PDF reader is required to view and print the forms below. Download Adobe Acrobat Reader

All therapists at Brassfield Center for Psychotherapy and Personal Development adhere to Health Information Portability and Acknowledgment Act (HIPAA) guidelines regarding information and privacy. You may review these guidelines by clicking the link below.
Notice of Privacy Practices

Forms for clients of Marilyn Wolf, MEd, LPC, LCAS
Professional Disclosure Form
Client Confidential Information Form
Consent Acknowledgement Form

Forms for clients of Harriet Bullock, MS, LMFT
Consent Acknowledgement Form
Confidential Client Information Form

Forms for clients of Heidi Birkner, MA, LPC, LCAS
Professional Disclosure Form
Patient Information Form
Consent Acknowledgement Form