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Mandy Young, M.A., LPC Intern

Supervised by kathy van Dusen, LPCS

Please complete the following forms and bring with you to your initial session.  This will allow us to complete the intake and assessment process more quickly.  We will review the forms at the first session, and I will be happy to answer any questions that you have.

Please note, for divorced parents of minor clients, please bring a copy of the custody agreement to the intake session so that I may verify who may consent to treatment.


For Child/Adolescent Clients:

Consent for Services​

Child Client Information Form

Child Psychosocial Inventory




Release of Information Form


Clients, please complete and sign this form if you would like me to share information with anyone else.

Forms