North Pointe Counseling Center
Our Forms/Resources
Form for new clients of Mike Finecey
Finecey Consent Form.pdf
Please complete and bring to your first session.
Form for new clients of Karen Merry
Merry Consent Form.pdf
Forms for all new clients of NPCC
NPCC HIPAA.pdf
Health Insurance Portability and Accountability Act. This document describes how medical information about you may be used and disclosed.
NPCC Intake Form,pdf
Client History. Please complete and bring to your first session.
NPCC Welcome.pdf
For all new clients. Welcome to our practice.
Additional Forms
Visa/Mastercard Authorization.pdf
For those clients who wish to pay with VIsa/Mastercard.
Release of Information.pdf
This form gives us permission to contact your other health care providers or professionals to coordinate your care.
©2008 North Pointe Counseling Center
5150 N. 16th St., Suite C-162, Phoenix, AZ 85016
(800) 273-3429
