New Client Forms

Please feel free to download the following new client information.  Several forms require your signature.  Please bring this paperwork to your first appointment with your provider.  If you have any questions you can call our offices at (717) 241-2345 or email Kim Bobo at kbobo@leedycounseling.com.  If you are seeing Sandra Abbey, CRNP for your first appointment you do not need to complete the form called “Client history questionnaire”.

Thank you and we look forward to working with you!

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Welcome to Leedy Counseling Services

Client Information Policies and Procedures

Client History Questionnaire- Adult Form – Note: This form is only for clients seeking counseling services. Additionally this form is not needed if only scheduling a medication evaluation.

Client History Questionaire- Children and Adolescents – Note: This form is only for clients seeking counseling services. Additionally this form is not needed if only scheduling a medication evaluation.

Policies for Counseling and Psychiatric Services

Health Insurance Portability and Accountability Act of 1996

Consent to Release Information to Insurance Carrier

Asperger’s Disorder Registration Form and Questionnaire

Fee Schedule

Payment Policy