• Call Us: 281-512-4734
  • Our Address: 11201 Richmond Ave, Bldg A, Suite 111A Houston TX
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Jacobs Ladder Psychological Services, PLLC

Forms for Clients

Jacobs Ladder Psychological Services

Required Forms

If you're a new client, please complete the following forms and bring them to your first therapy session. Adult clients need to only complete the Adult Intake Form. Minor children and families need to complete both the Child Intake Questionnaire and the Adult Intake Forms.
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New Adult Intake Questionnaire

This form is a adult intake questionnaire please complete and bring this form with you.

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New Child Intake Questionnaire

This form is a child intake questionnaire please complete and bring this form with you.

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Crystal Therapy Client Info Form

This form is for Jacobs Ladder Psychological Services Crystal Therapy Client Information, please complete and bring this form with you.

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Reiki Client Info Form

This client information form is for JLPS Reiki services, please complete and bring this form with you.

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Financial Agreement

This form is the written financial agreement for Jacobs Ladder Psychological Services. Please complete and bring this form with you.

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Patient acknowledgement of Privacy Form

This form is the acknowledgement of privacy for Jacobs Ladder Psychological Services. Please complete and bring this form with you.

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Jacobs Ladder Psychological Services Privacy Notice

This is the Jacobs Ladder Psychological Services Privacy Notice. Please review and keep for your records.

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