Documents and Forms

Intake Registration Form

This is the standard intake document that every client must completely fill out. It is available in-office or right here for your convenience. The file below can be printed and filled out prior to your appointment to expedite the process.

Release of Information Form

This is a release of information form which must be filled out completely in order for Victory to share any of your confidential data with a third party. 

Autism Assessment Registration Form

This is the registration form for an autism assessment. It is available in-office or right here for your convenience. The file below can be printed and filled out prior to your appointment to expedite the process.

Referral Form

This is the referral form used by Victory Counseling when accepting new patients. This form DOES NOT need to be filled out by the individual. For use by PCP, and referral departments.