• Delaware
    8:30 am - 8:00 pm Monday
    8:30 am - 8:30 pm Tuesday, Wednesday, Thursday
    8:30 am - 5:00 pm Friday
  • Mt. Gilead
    8:30 am - 8:00 pm Monday
    8:30 am - 5:00 pm Tuesday, Thursday, Friday
    8:30 am - 7:00 pm Wednesday
  • Individual counseling
    A collaborative effort between you and your counselor in an open, supportive, and confidential environment to address the issues
  • Group counseling
    Group members experience emotional support, empathic understanding, and authentic encouragement from one another
  • Couples & families
    We offer treatment options for couples and families
  • Women's & men's groups
    We offer Breaking the Cycle for women and gender specific treatment services for men
  • Prevention services
    We provide elementary school Too Good for Violence and middle school Too Good for Drugs

Forms

For CLIENTS

In order to save time at our office, you are welcome to fill out the forms that pertain to you prior to your arrival. (But please wait to sign any forms as they must be witnessed at intake—thank you.)


Intake Form

Includes client contact, demographic, and billing information.

Client Orientation Handbook

Includes client rights and services information.

 

Client Grievances

Statement to sign explaining how clients can file grievances.

 

Confidentiality of Client Records

Explains how client record confidentiality is maintained.

 

Gender Specific Issues

Provides information on issues specific to women.

 

Statement of Client Rights

Statement to sign explaining the rights of clients.

 

Information Sheet/Signatures

Assistance for clients with sensory impairments, missed appointment policy, treatment agreement.

 

Notice of Privacy Practices

Describes how client medical information may be used and how clients may get access to this information.

 

Drug Screen Contract

Client signature for drug screen contract.

 

Order for Urinalysis/Drug Screen

Client signature authorizing orders for screens.

 

Billing Authorization Disclosure

Authorizes information disclosure for billing purposes.

 

General Client Information Authorization Disclosure

Authorizes client information disclosure (revocable).

 

 

Criminal Justice Information Authorization Disclosure

Authorizes information disclosure for criminal justice system (conditionally revocable).

 


For TEACHERS and PARENTS

Teachers in Too Good for Violence (TGFV) or Too Good for Drugs (TGFD) classroms, you will find forms here to help you in your reporting as well as a number of helpful resource documents to use in class.

Parents of students taking TGFV or TGFD, you will find introductory materials and activity pages.