Islands Counseling

Janell W. Harvey, LPC

Marcia C. Barksdale, LPC

Marcia's Intake Forms

Janell Harvey, LPC

Janell's Intake Forms

Jessica Campbell, MA

Jessica's Intake Forms

Women's Issues Resources

Eating Disorder Resources

Hotline #s and Resources

Nutritional Eating

Directions

Please read all of the paperwork on this page before the first appointment.  Choose one of the options below to complete the paperwork required.

Option 1: (Preferred) Please fill out the Client Intake Form and the Adult OR Adolescent Form online, save as a document on the computer and email to Janell at jharvey@islandscounseling.com.  This is the preferred option.  Please read the other paperwork.  Please sign and bring in  ONLY the Confirmation Page.

Option 2:  If the forms are not completed online only the three pages listed below need to be printed and brought to the office.  First read all of the information on this page and then, fill out the Client Intake Form and the Adult or Adolescent Information Form.  These and the signed Confirmation page should be brought in on the first appointment.

Please bring your insurance card with you to the office so that we may obtain a copy for our records.  Thank you. 


CLIENT INTAKE FORMADULT INFORMATION FORM
CLIENT INTAKE FORM                              ADULT INFORMATION FORM

ADOLESCENT INFORMATION FORMCANCELLATION POLICY
ADOLESCENT INFORMATION FORM                                 CANCELLATION POLICY

DECLARATIONS OF PROCEDURES AND PRACTICESDISCLOSURE AND CONSENT
DECLARATIONS OF PROCEDURES AND PRACTICES                     DISCLOSURE AND CONSENT

HIPPA NOTICE  
                              HIPPA NOTICE
















Islands Counseling •  2953 Bienville Boulevard • Suite 145
  Ocean Springs • MS • 39564  • 228-324-5767