New Client Form Packet

New Clients, please fill out the forms in the Synergy New Client Packet below. They can be filled out online and emailed to Kristen, [email protected], PRIOR to your 1st appointment OR bring them to your first therapy session appointment along with your insurance information.

Included in the New Patient Packet are the following forms: Client Intake, Consent to Treat, Card Payment Authorization, Insurance, Financial Hardship, Disclosure/Release of Information, Telemental, Emergency Protocols and Covid-19.

Individual Forms

Synergy has its own cancellation policy which you will receive in your welcome packet. It affords you the opportunity to make-up your session, void of losing any money or time.

If you would like Gina to coordinate care with another provider (psychiatrist, primary care physician, etc.), complete the form below, allowing authorization to release psychotherapy information. Synergy's disclosure form is reviewed at intake.


Synergy of Spirit Counseling & Hypnosis Center is now offering teletherapy sessions. We have partnered with, LLC to ensure that all health rules & regulations are being adhered to. Please fill out the consent form below to participate.

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