New Clients

Thank you for choosing Carlock & Associates.

PLEASE NOTE: We do not accept credit cards. Your copay in CASH or by CHECK is due at the time of service or there is an additional $10 penalty charge.

Please print, complete and sign the appropriate forms below and bring them with you to your first appointment.

ADULT INDIVIDUALS (over age 18)

Please download forms here.
Please print all forms and fill out everything in its entirety.

FOR COUPLES

Please download forms here.
Please print all forms and fill out everything in its entirety.

FOR CHILDREN AND ADOLESCENTS (under the age 18)

Please download forms here.
Please print all forms and fill out everything in its entirety.

Parent or Guardian: Please fill out all forms with the child/adolescent’s information (i.e. name, birthdate, social security number) but sign your name. Have the adolescent (age 12 or older) fill out the Adolescent History form about him/herself. If the client is under age 12, please disregard the Adolescent History form.

Directions to both the Dayton and Vandalia offices are included in the client packet, as well as a form listing our fees.

Please make note of the NO SHOW and LATE CANCELLATION fees on the Office Policies page. If you need to cancel an appointment, we require 24-hours advance notice. If you give less than 24-hours notice, you will be charged for the full fee of the session because we cannot file this charge to your insurance. If you fail to show for your appointment, you will also be responsible for the full fee of the session. We do have voicemail available 24/7.