"Providing affordable, professional counseling services with intentions to empower, nurture and educate."
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    Client Forms (Download/Print All That Apply)

    Click each PDF icon below to download & print document.  Having trouble downloading the PDF? Contact Us for help.

    Adult (ages 19+) Intake
    Adult (ages 19+) Intake
    Child (ages 4-10) Intake
    Child (ages 4-10) Intake
    Marital Intake - Husband
    Marital Intake - Husband
    Adolescent (ages 11-18) Intake
    Adolescent (ages 11-18) Intake
    Informed Consent
    Informed Consent
    Symptoms Chart
    Symptoms Chart
    Crisis Plan Strategies
    Crisis Plan Strategies
    Marital Intake - Wife
    Marital Intake - Wife
    Financial Agreement
    Financial Agreement
    Credit Card Information
    Credit Card Information
    HIPPA Policies Brochure
    HIPPA Policies Brochure
    Release of Information
    Release of Information
    Telehealth Informed Consent
    Telehealth Informed Consent
    Adolescent Privacy Agreement
    Adolescent Privacy Agreement
    Marital No Secrets Agreement
    Marital No Secrets Agreement
    Volunteer/Donate

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    Address

    425 North Maysville St.
    Mount Sterling, KY 40353

    nscc.staff@newsongcounseling.org
    Tel: 859-497-0594

    Fax: 859-432-1025

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