Intake Forms

Once you have spoken with Matt and Suzanne, decided that EAP is a good fit for your needs, and arranged for your first appointment, please download the following documents. Please return them in a timely manner so that Matt and Suzanne have time to read them before your first session.

Please download, read, and keep these two documents.

Client/Therapist Contract

HIPPA Notice

Please download, complete, and mail the following five forms to: PO Box 1444, Mebane, NC 27302

CWF Signature Page

Client Profile form

Farm Liability Release Form

CWF Consent to Release Information

Consent to Share Information (Optional)(complete if you would like us to be able to communicate with anyone else regarding your treatment: doctors, other therapists, teachers...)

If you have trouble printing the pdf's as they open in your browser, try saving a copy to your local drive, then opening and printing the form.