Links to Forms

Consent forms and other important paperwork are available here for your review. I will advise you as to what forms you need to complete prior to your first appointment. Completing your paperwork prior to your first appointment is important, as it will allow us to devote more time to exploring your concerns, needs, and goals. Please let me know if you are unable to complete the paperwork ahead of time, and plan to arrive at least 20 minutes before your first appointment to complete it in my office.

Professional Disclosure Statement & Consent for Services

Credit Card Authorization Form

Referral/Authorization for Counseling Services

Release of Information

NC DHHS Client Rights

(Medicaid clients only)

Self-Assessment

(Medicaid clients only)

© 2016 by Amanda Kirby. Proudly created by Parker Wallman

Amanda Kirby

Counseling

Tel: 336-457-0827

Contact Amanda Kirby LPC
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